Out of the water closet: guilty secret of toilet terror revealed

Glasgow-based psychologist Alex Gardner estimates that tens of thousands of Scots are going to drastic lengths to avoid using toilets where they might be overheard going to the loo.

Some of those suffering from avoidant paruresis, or ‘bashful bladder’, have even fitted their own catheters to ensure they never need to use a toilet outside their own home.

Gardner said local authorities, pub and restaurant owners should start designing sound-proof cubicles with walls that stretch from floor to ceiling to help sufferers live a more normal life.

Gardner, who was the resident expert on ITV’s Fat Club series and is Britain’s only expert on the condition, said: "Some people won’t go to the theatre, they won’t go on holidays. And if they are too embarrassed to tell anyone, their partner begins to wonder why they won’t be seen in public with them."

Paruretics are physically unable to urinate if they think there are others nearby, forcing them to keep it in or to stay in.

"Sometimes people even have problems in their own homes because of the fear of being heard," he said.

Gardner, who offers workshops to those suffering from the disorder, estimates as many as 500,000 Scots, both men and women, could be affected by the disorder.

He is speaking at this year’s British Toilet Association in Stratford-on-Avon on Tuesday to try to raise awareness of the condition and to demand action from those who build and design public toilets.

He said: "People tend to form self-help groups where they become ‘pee buddies’, but there are no self-help groups in Scotland. The Scots tend to be very canny about coming forward. But once people start to share their experience they realise that other people are suffering from it too."

He added: "I’m working on the slogan ‘Encourage providers to install dividers’, and I would like to see everyone installing partitions in their toilets. There should be ceiling to floor dividers in the women’s toilets and partitions that go from head height to below knee level for the men’s urinals."

But Gardner’s demands have been met with criticism from local authorities, who claim there is a safety risk.

Raymond Reid of Aberdeenshire Council said: "If someone took ill in a fully closed cubicle, no one would be able to access them."

He added: "One of the biggest problems with carrying out alterations is that you don’t want to encourage undesirable group activities, particularly in gents toilets, which would become more difficult to supervise."

Gardner said standards in public toilets had got better and singled out for praise the bar chain JD Wetherspoons, which won the Overall British Loo of the Year in 2001 in a competition run in association with the BTA.

But he said the only long-term answer was therapy. "People have tried hypnotherapy, relaxation therapy, even soft drugs , but nothing seems to work apart from psychological treatment," he said.

Gardner has already worked with the International Paruresis Association to conduct workshops in England. Working on a series of ‘peeing practices’ which accustom patients to urinating in the vicinity of others, the workshops take the form of residential weekends.

Gardner is keen to bring the treatment north of the Border: "Without doubt there is the need for a workshop up here."

John Sinclair, consultant surgeon in urology at the Southern General in Glasgow, said the condition of not being able to urinate in public was very common, particularly in men.

"When the bladder empties, the bladder muscles are supposed to contract at the same time as the exit muscles relax. But if this doesn’t happen simultaneously then you have to stand longer and concentrate.

"It would be possible then to develop a psychological complex if you are standing in a public toilet. People will wonder why you are there if you are not urinating. They will wonder if you are there for another reason, a more sinister reason."

‘Thinking about it only makes it worse’

AS A teacher, you might think Margaret’s fears would centre around school inspections or angry parents’ evenings.

But the Falkirk teacher’s day is dominated by the fear of needing to use the school toilets. She goes for almost 10 hours every day without going to the toilet, and limits herself to one cup of coffee in the morning and evening and a cup of soup at lunchtime.

Only when she is within safe distance of her own bathroom, can she allow herself a couple of glasses of water.

"I’ve had this phobia ever since I was a young child," she says, "I don’t know where it came from, I’ve just never liked public toilets."

Margaret’s phobia means she has to keep her legs crossed when she’s out at night and ensures alcohol is more or less off limits.

"I would maybe have half pints but I wouldn’t drink very much. I’m not a very heavy drinker anyway but I think part of that is because of my problem," she says.

Holidays can also prove a nightmare. "One of the longest I’ve ever had to last without going to the toilet was when I went on a skiing holiday in Austria," she says. "I would go to the toilet before I left my hotel room and would then head up on the slopes all day.

"After ski class I would go for a drink with the group and it was only when I got back to my room that I was able to go to the toilet again." That was eleven and a half hours later.

Margaret, who doesn’t want her surname published, says she does not let herself think about going to the toilet. But she would like to share her suffering with others who have the same fears.

"The problem is that Scots don’t tend to talk about things like toilet habits. We get embarrassed , unless you’re Billy Connolly of course," she says.

I couldn't go to other people's houses

SIMON’S fear of going to the toilet in public has dominated his life.

The 32-year-old, who doesn’t want his real name revealed, said: "I have had to turn down social engagements. I couldn’t even think of going to a football match, I even had problems going to other people’s houses.

"This condition starts to take over your social life and your ability to do what you would normally do is completely affected. It is a very controlling factor in your life."

Simon’s fear is of being in the vicinity of others while he urinates. "There is this fear of being heard - an obsession with thinking about what other people are thinking of you. The problem is both a psychological and physical issue - it involves interaction between the brain and an involuntary muscle, so that you just freeze."

Simon believes he is almost cured now having come across a treatment called thought field therapy.

"It was my GP who suggested it to me and then I found someone on the net who deals with it. I’ve only seen them once but it has definitely made a difference."

The therapy involves him dealing with his "energy lines".

He said: "I am a lot more relaxed now, I have learned not to care about it quite so much."

But things are still not easy. When he was invited to a friend’s birthday party last month he had no choice but to turn him down because he knew there was no lock on the bathroom door.

"You end up just worrying about it for four or five days and then there’s no way you’re going to be relaxed about it. Thinking about the problem only makes it worse, but at least it’s getting better."