Shy bladder has reader in legal bind

Dear Dr. Roach: I have a problem called “shy bladder,” which has put me in a legal predicament. I was pulled over for speeding (which I was). After passing a breathalyzer twice, I was taken to the police station to give a urine sample. I was unable to do so.

I was told I was acting nervous, but I was on the verge of a panic attack from anxiety. Normally I wait in public restrooms until I am alone before I can go. If someone comes in, I will shut off as if there were a valve.

I was given a citation for DUI for refusal. I have an upcoming court date and was hoping for any useful information.

M.F.

Answer: I have no expertise in legal matters, and you need an experienced attorney more than medical advice at the moment. Still, I hope that an explanation of “shy bladder” — the medical term is “paruresis” — may be useful. It is more common than you might think; a conservative estimate is 3% of the population, with more of them men.

Many people occasionally have some difficulty urinating in public bathrooms, but to be diagnosed with the disorder paruresis, the symptoms must be severe enough to interfere with daily life. I can’t recall discussing this with a single patient, so it’s clear that many or most people are unwilling to bring this up with their doctor.

Paruresis is thought to be related to anxiety disorders, and people who experience it are likely to have other mental health issues, including depression and obsessive-compulsive disorder — or your anxiety-related panic attack. Treatment for paruresis is usually with cognitive-behavioral therapy.

I did some reading at the International Paruresis Association (https://paruresis. org/) and found some legal implications that might help you or your attorney, as well as information of general interest.

Dear Dr. Roach: I had two cardiac bypasses 30 years ago. The surgeon said the bypasses were good for about 10 years. As predicted, I began to have a little angina about 10 years after the surgery. About that time, I had read an article about external counterpulsation, but my cardiologist totally dismissed it. So I reasoned a way to get more blood to my heart: For 20 years, I have spent three to four hours per week lying on the sofa with my feet elevated about 45 degrees. I’m 87 years old and enjoy almost perfect health. What do you think?

C.W.

Answer: External counterpulsation has never caught on, despite the fact it was shown effective at decreasing angina and the need for nitroglycerine. It works by using cuffs on the calves, thighs and pelvis, and squeezing them in time to the person’s EKG. This reduces the amount of work the heart needs to do and provides a bit more blood flow to the heart. It also stimulates new blood vessels, but the exact mechanism of how it works remains a bit mysterious.

Raising your legs increases the return of blood to the heart through the veins. Since it is working on the vein side, not the artery side (where external counterpulsation is thought to work), it is not working the same way as ECP.

I can’t argue about your results, though. Being 87 and in almost perfect health is remarkable. I often discuss the value of exercise in older people, but maybe rest is important as well.

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