Most people take for granted the fact that when they need to relieve themselves, they just find a toilet and go. It might not be as private or comfortable as the one at home, but it serves the purpose. But to a significant minority, thought to be 7%, or 4 million in the UK, who suffer from avoidant paruresis (AP), this is not the case.

Paruresis sufferers have a phobia about relieving themselves in the presence of others. This can result in a physical block to urination. The severity varies from person to person. In the worst cases, they cannot use any toilet other than in their own home, and if other people are anywhere in the home, this can be impossible. In public toilets, some men cannot use urinals in the presence of other people, so they may resort to cubicles. In the worst cases, even that is difficult, or impossible, due to imagined noises, intruding thoughts or if others are outside in the toilets. Women also suffer from the condition, but fewer are affected.

The condition can cause great difficulty if a sufferer is called upon to give a urine sample in hospitals or clinics. In observed sampling, perhaps for a drug test, privacy is not catered for and an inability to provide a sample is interpreted as a refusal.

Sufferers adjust their lives to avoid situations they cannot cope with. These become a controlling factor in what they are or are not able do, in travelling, career choices, relationships etc. It is not uncommon for the individual to end up unemployed, for relationships to break down, and for him or her to suffer severe depression.

Little research has been done into the condition, but a common factor in those who have spoken out about AP is that they may have developed it during their time at school. Many paruretics (sufferers of AP) associate their condition with habitually avoiding using school toilets, holding on until they got home. This behaviour may have been prompted by a single unpleasant or upsetting incident in school toilets. Others cannot recall specific events like that, although they do refer to the state of the toilets, not being allowed to go when they needed to, and uncontrolled, anti-social behaviour in toilets.

Sustained school toilet avoidance may be sufficient to initiate the onset of paruresis. Toilets literally may have become a 'no go area'. Later in life, unconscious psychological mechanisms may exert a blocking effect: the roots of paruresis.

School toilet problems need addressing for a variety of health and hygiene reasons, but also to prevent them from playing any potential part in the development of AP.

Parents need to be aware and watch for the signs of public toilet avoidance. Typical signs are pupils who race to the toilet on arrival home on a daily basis, or who frequently come home at dinner time for that purpose. Sufferers also tend to restrict their fluid intake to minimise the risk of a full bladder, and this also needs to be identified.

There is some opinion that the ability to go in communal settings is a 'use it or lose it' skill. This means that help and therapy may be required to kick-start the return to normal behaviour.

The United Kingdom UK Paruresis Trust, a registered charity, provides information and workshops to help those lives are devastated by this condition. Their website is at www.shybladder.org.uk.

It is quite common for children and young people to be unable to use the toilets when there are lots of other pupils around. This is one of the reasons why pupils need to be allowed to go to the toilet during lessons - the only time that offers privacy.

Sustained school toilet avoidance may be sufficient to initiate the onset of paruresis. Toilets literally may have become a 'no go area'. Later in life, unconscious psychological mechanisms may exert a blocking effect: the roots of paruresis.

This condition can also affect people's ability to defecate, though by its nature this is usually less of a problem. An information site about this may be found at http://home.freeuk.net/parcopresis/.

This page was approved by Professor Alex Gardner, Chartered Psychologist and Psychotherapist, Honorary Advisor to the UK UK Paruresis Trust.