Researcher creates tool to diagnose ‘closet’ phobia

Millions may be suffering in silence with an embarrassing anxiety.

Terrified of going to the toilet

Today is World Toilet Day and all around the globe, people are fundraising to help introduce sanitation to Third World communities without it.

“Our goal is the same each year: we want to make it normal for everybody to talk about toilets, and how they save lives. One in three people worldwide still don’t have access to a decent toilet,” according to the campaign.

In the west, there is trouble with lavatories of a different nature … the psychological condition known as toilet anxiety.

The fear of toilets is a real phobia for many adults, says Dr Simon Knowles, a Melbourne academic at Swinburne University.

He is developing a free psychological intervention to help the estimated 6.5 to 32 per cent of Australians who experience toilet anxiety to some degree.

Generally, the anxiety manifests due to:

  • having difficulty urinating or defecating
  • the use of a public toilet
  • being too far from a toilet
  • the fear of having an accident in public
  • other people being able to hear or see you use the toilet
  • the lack of cleanliness of public toilets
  • being confined in a small space.

Many individuals will ‘hang on’ until they get home rather than use public amenities, Dr Knowles says. Others who fear ‘losing control’ plan their outings meticulously to ensure that they are never far from a toilet.

According to the researcher’s website,, the fear has been given several medical names, depending on the individual’s specific concern.

For example, fears or difficulties related to urination may be referred to as psychogenic urinary retention, paruresis, shy bladder syndrome or bashful bladder syndrome.

Fears or difficulties related to defecation may be referred to as psychogenic faecal retention, parcopresis or shy bowel syndrome.

And fears related to being too far away from a toilet may be referred to as toilet proximity anxiety disorder.

In 2016, Dr Knowles published a paper which presented a scale that clinicians could use to evaluate patients with shy bladder (paruresis) or bowel (parcopresis) syndrome. It was based on a study involving 720 participants.

“Paruresis and parcopresis-related concerns were associated with social anxiety,” the study found.

“Although yet to be explored in the literature, the experience of paruresis and parcopresis may also be higher in individuals who have an underlying bladder or bowel condition, such as prostate disease or Inflammatory Bowel Disease.

“It is expected that those living with a bladder or bowel condition may be more anxious with regard to utilising a public toilet due to the potential for their symptoms to be displayed in public, for example, being unable to urinate.”

Included in the analysis were findings from other studies into these conditions:

  • Like other social phobias, individuals with paruresis demonstrate anticipatory anxiety and fear of negative evaluation, with urinary difficulties that increase as the level of privacy decreases. In addition, this anxiety often leads to avoidance behaviours and limited social functionality.
  • Bowel movements may even be a greater threat for psychological distress than urination, due to the more obvious sounds and smells, as well as the general shame and embarrassment that people tend to associate with defecation.

Although males scored higher on the shy bladder scale compared to females in the current study, the opposite pattern was found for shy bowel, in which females scored higher than males, Dr Knowles said.

According to, individuals with toilet anxiety use a number of strategies to cope with symptoms, such as:

  • reducing fluid intake in order to avoid using a public toilet
  • seeking public toilets that offer greater privacy
  • choosing to use cubicles over urinals
  • avoiding social activities, holidays, parties, dating, sporting events, and other occasions where the toilet situation may cause anxiety.

“The difficulties associated with toilet anxiety can have a significant impact on quality of life,” Dr Knowles said.

“Not only do sufferers notice that it impacts upon their social activity, but it also has consequences for their work. Anxiety around toilet usage can influence the type of work environment that an individual is comfortable in.

“Toilet anxiety can also cause considerable shame among sufferers, and the majority do not seek assessment or treatment.” has some resources to help sufferers, including instructions on using cognitive diffusion and mindfulness to release fears.

Do you avoid using public toilets? Do you believe practising relaxation techniques might benefit individuals who suffer from toilet anxiety?



    To make a comment, please register or login
    19th Nov 2018
    I try to avoid public toilets in Australia as much as possible because they are invariably filthy (and I'm no cleanliness freak).
    Asia, on the other hand, is usually a case of two extremes - either no public toilets at all or full-time, on-site attendants to keep them in at least a semblance of reasonable order.
    I look forward to the day that councils, supermarkets, pubs, etc in Australia adopt the second option...
    19th Nov 2018
    A little unfair - I would say 80% of toilets here are fine - but do
    agree some Shopping malls need to lift their game.
    19th Nov 2018
    Impossible to allocate accurate numbers without a simultaneous inspection of all public toilets throughout Sydney(!), but I'd say it's best to steer clear of a lot more than 20% of the public toilets at least in and around the CBD and inner city.
    But my main point was to recommend full-time on-site attendants responsible for keeping toilets clean. It's not a very nice job, given the state that some of the toilets are left in by our fellow citizens, but certainly a necessary one in terms of widespread comfort and hygiene - not least so we can avoid the same outcome that pervades at least one SE Asian country: that of males publicly urinating against walls, trees, etc, often without any attempt at disguising their activity (and no, they're not Aussie rugby league players after a night on the town!).
    19th Nov 2018
    New term: Anticipatory Urination - as soon as I drive into my driveway coming home perhaps late at night, I need to go, in a big HURRY!
    19th Nov 2018
    There are more people with mobile phones in the world than there are people with access to safe and clean toilets.

    21st Nov 2018
    I’m shit scared of using toilets

    Tags: health, bladder, bowel,

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