Anxiety, Scratching and Avoiding the Toilet

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Reader’s Question

I need help with understanding my problem: is it a symptom of something, does it happen to others, maybe it has a name? I want to understand where it’s coming from and how to deal with it.

I’m keeping myself from going to the toilet.

When I feel the need to, in the morning, or when I need to urinate, I hold it. Even if I’m at home and there is nothing stopping me from going. I hold it in sometimes for two days, and it’s not related to constipation. And with urinating, I also postpone it for as long as I can.

When I was in kindergarten I remember having the same problem. I didn’t like the toilets there, and sometimes my underwear got stained. It has continued ever since, but in a light form. I now acknowledge it as a big problem because it has become a lot worse. This coincides with a serious 1.5-year relationship that just ended: my problem started to get worse at some point during this relationship because things were very complicated and painful.

I also remember an episode in my childhood, before elementary school, when my family went to a concert and I needed to use the restroom and my dad got really angry and was very bothered that he had to take me out me and then we couldn’t come to our seats until the break. There were other times when I remember not telling him I wanted to go to the toilet when we were out in the city because I was afraid he would get mad, and as a result I was getting my underwear a little dirty.

My ex-boyfriend made a scene one time I had gas; he was very angry about the smell and said it’s disrespectful, even though it was an accident and I felt awful about it — and it happened only four times during a 1.5-year relationship. Yes, I counted. I was embarrassed and worried about another scene when I needed to to use the toilet when I was at his place, and I basically lived there for almost a year, and was trying to use the toilet only when he wasn’t there.

I also have some signs of anxiety that started in my teenage years once I started to have zits and pimples. I’d scratch them and try to get them out, and they’d make a crust which I’d scratch off with my nails, and it would leave a scar. This is a bit less on my face, but mostly on my shoulders and chest. This got worse during this relationship as well. I would scratch everything: my face, even my scalp trying to find any imperfection on my skin and tear it off with my fingernails. Most of the times I’m not aware I’m doing it and I can’t control it.

Psychologist’s Reply

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From what you’ve described, it sounds like you are struggling with anxiety that is expressing itself in the toilet problem and the scratching. You’ve mentioned two things in your past that support the theory that this is anxiety. However, you have not mentioned whether you’ve been checked by your primary care doctor for a medical cause. That has to be ruled out first before you conclude that this is strictly a psychological issue.

If this is not caused by a medical issue, it soon could become one. There is a real risk that you will damage your body by holding your urine for so long. I applaud you for seeking help, and I encourage you to follow up and get more help from your doctors nearby.

While you are seeing your primary care doctor, ask her if she is willing to prescribe a psychotropic medication for you. Some doctors are willing to do this, some are not. If your doctor is not willing, then consult with a psychiatrist as soon as possible. Immediate relief from these symptoms is warranted.

To answer your other question, yes, this does happen to others. I’ve treated a patient who struggled with this for years. In that case, there were psychological causes just as you have described. And yes, therapy was successful. She was able to regain control of normal body functions. She did it through a combination of psychiatry and insight oriented therapy.

Although insight oriented psychotherapy can be effective, it may also have consequences for your relationships. For example, when your boyfriend shamed you for passing gas, did you stand up for yourself? Perhaps you made an attempt to defend yourself, but it sounds like he overwhelmed you with his criticism. The result was an increase in your holding behavior and sense of embarrassment. But imagine: what if you had really stood up for yourself? What if you had stood your ground and made him back off? What if he had ultimately apologized to you for shaming you for something that was purely an accident (and a very minor accident at that)? I would imagine that your relationship might have taken a different twist, but you would not have seen an escalation in your holding behavior.

You sound like a very sensitive person who does not tolerate criticism well. Also, I notice that both of these unpleasant incidents happened with men. Therefore, it might be easier for you if you search out a gentle, female therapist (and psychiatrist and primary care doctor) so you can talk freely about these issues.

It sounds like you have a lot of anger and anxiety you are holding along with your urine. You may still be afraid to let that out for fear of retaliation by those around you. Find a safe person to talk to, convince yourself it’s safe to talk and emote — and yes, to fart if you need to — and let it out.

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