Q: What does a "medical screen" mean?

A: Difficult urination is a symptom similar to a high temperature reading. There are several potential physiological causes. The excellent book: Conquering Bladder and Prostate Problems, The Authoritative Guide for Men and Women by Jerry G. Blaivas, MD, lists several causes of difficulty urinating, such as spinal cord injury, multiple sclerosis, diabetes mellitus, urethral obstruction, stroke, too little urine in the bladder, or a weak bladder. Under the category urethral obstruction, the author lists vesical neck obstruction, prostatic obstruction, urethral stricture (scar), or learned voiding dysfunction (paruresis falls into this category).

We recommend that all IPA members and posters to our Discussion Board get a medical screen to rule out physical causes of urinating difficulty before assuming that the cause is psychological (paruresis). We have had one poster who participated for several months on our Discussion Board before his doctor diagnosed a mild case of multiple sclerosis.

We know of no definitive test for paruresis as insufficient research has been done in this area. From the anecdotal information we receive on our Discussion Board, many cases are first identified through an onset of symptoms between 10 - 25 years of age, although there are cases where symptoms appear outside this age range. The classic symptom of paruresis is normal urination when in the privacy of one's home, with much greater difficulty being able to urinate in a public restroom with others present. One should always get a medical screen from a qualified doctor for sudden onset of urination difficulty or for a sudden worsening of what is thought to be paruresis. People with paruresis commonly think of any urinary symptoms as paruresis related, not considering that they are also subject to urinary tract infections, prostate enlargement, and any number of other physical causes which will benefit from a doctor’s immediate attention.