Brief Answer: Graduated exposure therapy works Detailed Answer: Hi XXXX, Thanks for writing in to us. Shy bladder problem or paruresis is a condition that prevents people from urinating in public, sometimes even in their own homes if others are in adjacent rooms. Any medical physical condition must be excluded before a diagnosis of shy bladder is made. If you have no medical reason for difficult urination and can go at home when alone without a problem but have difficulties in most, or all, social situations, then you probably suffer from paruresis. Very less research has been done on this condition but there are promising treatments which can cure this problem completely. Once such treatment that works in many people is graduated exposure therapy and is best under guidance of a psychiatrist or psychologist. This is a part of cognitive behavior therapy and involves the individual gradually attempting to urinate in more and more difficult locations. Some of the important points of therapy are as follows: Each session of exposure therapy involves several attempts at briefly urinating. In order to use exposure therapy a substantial amount of urine is needed. This need can be accomplished by drinking plenty of fluids prior to the practice session. Usually drinking about two to three glasses of water one hour prior to the practice session is best. Some people may require more water or more time to pass before they feel the strong need to urinate. Most people with shy bladder are more successful if their need to urinate is high at the time of the practice session. Occasionally, some people have more trouble when they are very urgent, so experimentation may be necessary. Some find it helpful to use a scale to record scale to record how strongly one feels the need to urinate. A 0-10 point scale works well starting with zero indicating no urgency and ending with ten, which equals extreme urgency. It will probably work out best to start practice sessions only after your urgency level is rated at seven or above. If you have trouble initiating urination, wait at the toilet for two minutes before giving up and taking a break. If you feel that you are just about to urinate after two minutes, wait up to two minutes more at the toilet before giving up. Usually waiting beyond four minutes is not helpful. If the trial is unsuccessful, take a short three-minute break before trying again. The solution given by me may seem a bit complicated but you can easily overcome your problem with repeated attempts. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

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Brief Answer: Please visit NIMHANS at Bangalore Detailed Answer: Hi XXXX, Thanks for writing back with an update. Bangalore has NIMHANS which is among the best psychiatry institutes in India. You may try approaching doctors over there and discussing your problem in detail. Hope your problem is solved soon. Regards, Dr.Vivek

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