How common is pee anxiety?

For about 21 million Americans, roughly 7% of the general population, urination causes great worry and inconvenience. They have developed a condition called paruresis also known as shy bladder syndrome, pee shyness, or bashful bladder.

nationalsocialanxietycenter.com - SHY BLADDER SYNDROME (PARURESIS)

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Paruresis is a Type of Social Anxiety

For the vast majority of people, tending to bodily functions such as urinating happens without much thought or concern. For about 21 million Americans, roughly 7% of the general population, urination causes great worry and inconvenience. They have developed a condition called paruresis also known as shy bladder syndrome, pee shyness, or bashful bladder. The word “paruresis” is derived from the Latin meaning “abnormal urination.” Paruresis is a form of social anxiety disorder effecting both men and women. Faced with needing to urinate in public places or in the presence of others, the paruretic experiences significant anxiety over the possibility of being judged by others. Typically, the fear is centered on what others’ would think if the paruretic were unable to initiate the flow of urine. The judgments include: “They’ll think there’s something wrong with me if they don’t hear peeing.” “I’ll be judged as less of a man if I can’t urinate where others can.” “The stream of my pee sounds too weak as it hits the urinal.” Also, the anticipation of not knowing if one will be able to urinate can exacerbate anxiety and self-consciousness; hence making the act of urination difficult if not impossible. The precise cause of paruresis is unknown. Most paruretics say that their paruresis began in late childhood or adolescence. They often pinpoint the beginning of the disorder to an event where they felt pressure to urinate with others nearby. The pressure to “perform” led to stress and anxiety to urinate. If they were unable to void, they may have experienced ridicule from others. That trauma coupled with the fear of not being able to urinate in future situations came to be the genesis of the problem. As with all mental health concerns, the severity of paruresis varies from person-to-person. Some paruetics are mildly inconvenienced by the occasional inability to urinate in specific settings, i.e. sports arena restrooms with long lines of impatient fans waiting for the urinal. Others experience significant impairment in most settings when faced with the need to urinate. These individuals can become house bound as they fear needing to void without having a “safe” bathroom within close reach. People who undergo urine testing for employment are also greatly impacted. Others may avoid long airline flights for fear of enduring the painful experience of not being able to urinate.

Cognitive-Behavioral Therapy (CBT) for Paruresis

Cognitive-Behavioral Therapy (CBT) is helpful in reducing the impact of paruresis. Graduated exposure (GE), one of the powerful ingredients of CBT, helps paruretics learn new associations between the feared stimulus (restrooms or situations that previously elicited extreme anxiety) and the ability to successfully void. When anxiety is heightened due to either the inability to urinate in the presences of others (primary paruresis) or the false meaning assigned to not being able to urinate, i.e. “I’m less of a man,” etc. (secondary paruresis), the brain triggers a physiological reaction that constricts the bladder’s ability to void. Through repetition, the paruretic learns to manage anxiety and to retrain the brain-bladder connection by learning that the feared stimulus is not something to be feared. Those concerned with paruresis should first visit their primary care provider or urologist to rule out medical causes. Well-trained CBT therapists, like those associated with National Social Anxiety Center, may have expertise treating paruresis. Finally, the International Paruresis Association provides a wealth of resources and workshops to help those afflicted by shy bladder.

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What age is best to conceive twins?

Women who are over age 30 — especially women in their late 30s — have a greater chance of having twins. That's because they're more likely to release more than one egg during ovulation than younger women. Mothers between ages 35 and 40 who already have given birth have an even higher chance of conceiving twins.

healthline.com - How to Conceive Twins: Tips for Having Multiples - Healthline

Medications designed to increase fertility typically work by boosting the number of eggs produced in a woman’s ovaries. If more eggs are produced, it’s also likely that more than one can be released and fertilized. This occurs at the same time, causing fraternal twins. Clomiphene and gonadotropins are commonly used fertility drugs that can increase your chances of having twins. Clomiphene is a medication available only through prescription. In the United States, the brand names for the drug are Clomid and Serophene. The drug is taken by mouth, and dose will depend on a person’s individual needs. It works by stimulating the body’s hormones to cause ovulation. Studies have shown that women who use this drug for fertility treatment are more likely to have twins than those who don’t. Gonadotropins describe a type of fertility medication given by injection. Follicle-stimulating hormone (FSH) is given by itself or combined with luteinizing hormone (LH). Both hormones are made naturally by the brain and tell the ovaries to produce one egg each month. When given as an injection, FSH (with or without LH) tells the ovaries to produce multiple eggs. Because the body is making more eggs, there is a higher chance that more than one will become fertilized. The American Society for Reproductive Medicine estimates that up to 30 percent of pregnancies that occur while using gonadotropins result in twins or multiples. Both of these drugs are generally considered safe and effective. But like any medication, there are potential risks and side effects that go along with using fertility drugs.

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