Why Can't I Pee in Public Restrooms?

If you've landed on this page, you've probably experienced the following situation: You're in a public restroom and need to pee, but nothing comes out.

I've been in this situation many times myself. In this article, I'd like to offer some guidance: Why can't you pee, even when you try really hard? Why does this happen to you in public restrooms? And when should you seek help?

Before we take a closer look at the processes involved, two things first: The problem is classified as a social anxiety disorder and is known as paruresis. And it is quite common. In Germany alone, an estimated 1.5 million people are affected.

The physical level: When you can't go

In order for urine to flow out of the bladder, both the external and internal sphincter muscles of the bladder must relax. If you are on the toilet and nothing comes out, it is the contracted internal sphincter muscles that are blocking the way.

The tricky thing is that you cannot consciously control these internal sphincter muscles. They are controlled by the autonomic nervous system, which also regulates our heart and breathing rates, for example.

Normally, the autonomic nervous system automatically ensures that the internal sphincter muscles relax when you want to urinate. However, this automatic mechanism only works if you are mentally relaxed.

If you are stressed or anxious, the internal sphincter muscles remain contracted. Then you can no longer urinate, no matter how hard you try.

Perhaps you have heard of fight-or-flight mode? Contracted sphincter muscles are a characteristic of this mode. You cannot urinate because your body has activated fight-or-flight mode in response to stress or anxiety.

The mental level: inner tension in public toilets

There is no universal explanation for why tension arises in the toilet. I would explain it simply as follows: evolutionarily speaking, we all need a safe place to pee, and we feel tense when this space is violated by other people. These may be people who are already in the toilet or waiting outside, but also people who could theoretically still come in. Our privacy is then violated in a concrete way because we feel exposed to observation and judgment by others in an intimate moment. We then imagine, for example, that others are asking themselves, “How long is that taking?” or “What noises is she making?”

Our safe space is not only defined by distance, but by a variety of factors, such as the noise level in the toilet. If music is playing in the background and a loud hand dryer is blowing, we feel less observed than if it is completely silent.

Similarly, different people can have different degrees of influence on our safe space. The judgment of a stranger at the airport is less relevant to us than that of our boss at the urinal next door.

From one situation to a continuous loop

How did you feel after you couldn't urinate for the first time?

In the best case, you thought, “Okay, I couldn't pee now, but who cares?” and forgot about the situation right away.

But life isn't usually that simple. It's more likely that you felt ashamed and perhaps thought you were strange. The next time you went to the toilet, you probably thought, “I hope that doesn't happen to me again!” and felt even more stressed.

This is the typical development that leads to the anxiety disorder paruresis. There is an initial negative experience. Then we fear that it will happen again. Then it actually happens again and our fears are confirmed. We increasingly associate public toilets with a threat to which our body inevitably reacts with the fight-or-flight response.

The problematic avoidance of “dangerous” toilets

Anyone caught in the vicious cycle described above automatically starts avoiding difficult toilets.

• Using the “safer” toilet, even if it is further away
• Drinking less to make it home
• Declining an invitation to avoid an unpleasant toilet

Even if this saves you toilet stress in the short term, toilets will seem all the more threatening in the long run. Above all, however, you miss out on the things you would actually like to do.

It's OK not to be able to pee in all toilets.

However, when it comes to avoidance behavior, it's important to be honest with yourself. Are your relationships with important people in your life suffering? Does toilet stress influence your career decisions?

Looking ahead

If you come to the conclusion that your fears about public toilets are significantly limiting you, then I want to encourage you: you can change your situation! There are proven ways to overcome your fears.

I have written another article that describes the path to recovery: How to overcome your paruresis?