Have you ever approached the urinal in a public bathroom, only to have your pipes suddenly freeze up when you try to pee? If so, you can count yourself among the millions of Americans living with paruresis, "or shy bladder syndrome."

Paruresis is a common social phobia that makes it difficult (or impossible) to urinate with other people standing by. For a guy with a shy bladder, a crowded public bathroom filled with urinals is his worst nightmare. Imagine having a few ballpark beverages and freezing up every time you try to pee in between innings. The pain of holding it through an entire ballgame is excruciating.

We envision a world in which DUDEs can approach any toilet with confidence. Accordingly, we investigated the potential causes of paruresis and put together some handy tips to help you pee peacefully.

What Is Paruresis, AKA Shy Bladder Syndrome?

Paruresis is a social anxiety disorder that causes people to have trouble urinating when others are around, usually in public restrooms. It's a legitimate medical condition recognized by urologists worldwide.

Paruresis is very common, affecting up to 25% of people in the US alone. There's even a not-for-profit organization called the International Paruresis Association, which offers support groups for pee-shy people.

Paruresis affects everyone differently. Some people only have a slight delay starting their stream. But in severe cases, people are literally incapable of peeing anywhere besides their toilet at home. 

Other common signs and symptoms of paruresis include:

• Avoiding urinating in public toilets
• Peeing in private stalls instead of urinals
• Experiencing dizziness, dry mouth, sweating, or fast heart rate in public restrooms
• Not drinking fluids away from home

The term "paruresis" was coined in 1954 by Williams and Degenhart in a research paper titled "Paruresis: a survey of a disorder of micturition." They surveyed 1,419 college students and found that 14.4% had shy bladders.

Today, paruresis goes by many other names, including:

• Pee shyness
• Shy bladder syndrome
• Bashful bladder
• Psychogenic urinary retention
• Avoidant paruresis
• Stage fright

It's crazy to think that millions of Americans choke at the bowl every day—but it's even crazier to think that 90% of people with shy bladders are DUDES.

Why Do So Many Guys Have a Shy Bladder?

The International Paruresis Association estimates that 9 out of every 10 people with shy bladders are males. What gives?

Paruresis is a complex and poorly studied condition, so it's hard to pinpoint precisely why shy bladder syndrome disproportionately affects DUDES. But we have a theory.

When it comes to public bathrooms, guys have to pee in close quarters, sometimes without a barrier between urinals. This can make you feel like you're being judged or "checked out," even if the guy next to you is having the same exact plumbing issues.

On the other hand, ladies get a private stall by default where they can zone out and relax.

What Causes Paruresis?

To fully understand shy bladder syndrome, we must consider the physical and mental mechanisms at play.

Paruresis triggers an adrenaline rush, which causes your sphincter and/or bladder neck to tighten. If those body parts can't relax, urine can't flow out of the urethra. There are several theories to explain why the nervous system responds like this.

Adults with stage fright often develop the condition in school as children, which makes sense. It's the first time you're regularly going to the bathroom in the presence of others. You're practically guaranteed to have a mean teacher who doesn't allow bathroom breaks, which gives you ample opportunity to hone your "holding it" skills.

Many people age out of being pee-shy. But for some, it prevents them from enjoying social events and really puts a dent in their quality of life.

Some doctors believe paruresis stems from post-traumatic stress disorder (PTSD), like getting bullied in the bathroom as a kid. It could also be due to self-consciousness about your pee's color, sound, or smell.

So what's a DUDE to do if you can't pee in front of other DUDES? 

5 Tips to Overcome Shy Bladder Syndrome

If you consistently choke at the bowl, try these techniques to break the dam and get that yellow river flowing again.

1. Flush Before You Pee

Some people who get stage fright are embarrassed about the sound their pee makes when it hits the toilet. One way around this is to flush before you try to pee. This drowns out the sound of your pee and anyone else's if you're in a crowded public bathroom.

2. Listen to Some Music

Again, we're trying to drown out the sound. If you feel like you're on a timer because of the length of the flush, grab your phone and headphones and turn on one of your favorite songs.

You won't be able to hear your peeing or anyone else's, and you're also distracting your brain from the problem at hand.

Try this out at home by putting a Bluetooth speaker in your bathroom to see if it helps your flow.

3. Do Mental Math

Because shy bladder is a social phobia, it's all in your head. Doctor DUDES recommends doing math to distract your brain from the task at hand. While we're nerding out, you can also tell a lot about your health by checking out your urine.

4. Scratch Your Butt

A DUDE on Reddit found an interesting way to get your pee flowing. He claimed it worked 80% of the time: Very lightly scratch the area right above your butt crack. Hey, whatever works, right?

5. Get Exposed

A common cognitive behavioral therapy (CBT) technique used to treat social anxiety is "graduated exposure therapy." It involves trying to pee in increasingly difficult places.

Start on your home turf with your roommate outside the door. You could move on to peeing with your significant other in the bathroom with you. As time goes on, the idea is to continually expose yourself to your anxiety about peeing and eventually break down your fear of peeing in public.

If this doesn't do the trick, the International Paruresis Foundation mentions psychotherapy and hypnotherapy as potential solutions. 

We hate to even bring it up, but the worst cases of paruresis require self-catheterization, which means you stick a tube up your penis to manually drain the urine. Let's hope you don't let your shy bladder get that serious.

Pee In Peace

Having a bashful bladder isn't something you have to keep quiet about—millions of DUDES deal with a kinked-up hose. Luckily it isn't a physical condition but a mental one, and there are plenty of ways to conquer it so you can go back to living the DUDE life.

On the bright side, you don't have to worry about peeing your pants in public.