What is Shy Bladder Syndrome?

Paruresis, commonly referred to as "shy bladder syndrome," "bashful bladder," or "pee shy," is defined as an inability to urinate in the presence—real or perceived—of others. Medically, it is classified as psychogenic urinary retention.

Recognized as a social anxiety disorder rather than a social phobia, paruresis affects individuals of all ages, genders, and backgrounds.

Those who experience this condition are often termed Avoidant Paruretics (or APs), as they tend to avoid situations that trigger their inability to urinate.

In collaboration with the UK Paruresis Trust (UKPT), we aim to provide valuable information for individuals who may be affected by shy bladder syndrome.

Urine drug testing and Shy Bladder Syndrome

At our company, we recognise that the collection of urine samples for drug testing can feel invasive. Therefore, we always offer alternative sample collection methods for individuals and organisations conducting drug tests.

When a urine sample is a regulatory requirement, we have implemented protocols and policies to minimise any discomfort or anxiety experienced by the donor, particularly regarding potential discrimination and existing medical conditions like paruresis.

For instance, we ensure privacy and provide secure toilet facilities for sample donors. Our sample collection officers do not observe the urine collection, employing measures to prevent sample adulteration, such as using blue dye in toilet bowls and cisterns and applying tamper seals to taps and water sources.

In cases of shy bladder syndrome, many of our workplace testing clients have established contingency methods, often opting for saliva samples instead of urine.

However, some safety-critical industries require urine samples without the option for saliva. For example, Network Rail does not permit saliva contingency testing on site. Their standards mandate that any donor unable to provide a sample must be evaluated by a medical review officer (MRO) before any result is recorded as a FAIL or NO RESULT. The MRO will review each case individually, and this is the appropriate stage for submitting medical evidence supporting the donor's claim.

We also encourage individuals and organisations to disclose any medical conditions that may affect a drug test prior to testing. Companies implementing drug testing programs often allow employees time to raise concerns. This applies to new employees as well, who can review the company’s drug and alcohol policy and address any issues before being asked to provide a urine sample. Whenever possible, using saliva samples instead of urine is recommended.

Finally, we emphasise to our workplace drug testing clients the importance of best practices. Donors who cannot urinate due to paruresis should not face discrimination or be deemed to have failed a drug test. Our chain of custody forms are designed to document instances of non-conformance regarding sample collection. Consequently, these situations will not be classified as failures but will instead trigger the collection of a contingency sample, such as saliva, or revert to the organisation’s drug and alcohol policy.

Further help and support for Shy Bladder Syndrome

As previously mentioned, we have collaborated with the UK Paruresis Trust (UKPT) to address the important issue of shy bladder syndrome and its relevance to urine drug testing.

The UKPT offers excellent support and advice for those suffering from paruresis. You can learn more about their mission and resources here.

In addition, the UKPT provides specific information related to drug and alcohol testing and has created a guidance leaflet on paruresis. This resource can be invaluable for individuals, testers, and legal representatives alike.