“Painfully Awkward Rob Lowe” Ad under Attack by “Shy Bladder” Advocates

Have you seen the DirecTV ad where fanny-pack wearing “Painfully Awkward Rob Lowe” is mocked for subscribing to cable? At one point, Lowe is seen standing in front of a urinal saying ” I can’t go with other people in the room.”

Members of the International Paruresis Association are upset with the commercial, as they say it makes fun of a serious medical condition, called paruresis. More commonly referred to as “Shy Bladder,” “Bashful Bladder,” or “Pee-Shy,” sufferers find it difficult or impossible to urinate in the presence of others. For some this can be quite disruptive to their lives.

Steve Soifer, CEO of the International Paruresis Association, has requested that DirecTV remove the ads:

“We don’t mind if people have a little fun with it. It’s a situation that a lot of people don’t understand. In this particular case, the portrayal is making it look ridiculous, that this guy is a loser for having a problem.”

However, DirecTV is standing firm. A spokesperson, Darris Gringeri, said it plans to continue airing the spots:

“The ads will continue to run for the vast majority of viewers who have told us they enjoy the spots and understand that, like all of our commercials, they take place in a fantasy world and are not based in reality.”

What do you think? Should the ads be removed?

What is Paruresis, or “Shy Bladder” ?

Paruresis is a social phobia that involves fear and avoidance of urinating where others may be present. Sufferers feel that are “unable to go” under these circumstances. There is no physical blockage of urine in these patients, as may occur with men with enlarged prostates, or blockage by a kidney stone.

The severity can vary from relatively mild- not being able” to go” at a urinal but being OK in a bathroom stall, to severe- not even being able to urinate at home if someone else is in the house.

Severe paruresis can affect a person’s life in a similar way to agoraphobia, which is anxiety about being in places or situations from which escape seems difficult (typically, fear of crowds or being outside the home). If a person can only successfully urinate when home alone, they may avoid leaving the house. This can reduce quality of life and curtail job opportunities.

It is estimated that about seven percent (7%) of the public, or 21 million Americans (220 million worldwide), may suffer from this disorder.

Social phobia, also called social anxiety disorder, is diagnosed when people become overwhelmingly anxious and excessively self-conscious in everyday social situations. People with social phobia have an intense, persistent, and chronic fear of being watched and judged by others and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends. Paruretics, in particular, face difficulties ranging from work problems (when they have to submit a urine analysis for drug testing), to traveling on long plane rides, to everyday social situations.

While many people with social phobia realize that their fears about being with people are excessive or unreasonable, they are unable to overcome them.

Other physical symptoms may accompany social phobias, and these include blushing, profuse sweating, trembling, nausea, and difficulty talking. When these symptoms occur, people with social phobia feel as though all eyes are focused on them.

It is unknown what causes paruresis. Although many with the disorder can’t identify any specific event that may have triggered it, others “believe their ailment was triggered by a traumatic incident that happened prior to or during adolescence including embarrassment by a parent, teasing by classmates or siblings, harassment in public bathrooms or sexual abuse.”

How is paruresis treated?

Most patients with paruresis should first be seen by a urologist (urinary tract specialist) to ensure that there are no physical problems causing the condition. They can also educate the patient, stressing that there are many others with the same problem. They can also refer the patient to a professional who is qualified to deal with anxiety disorders.

Other forms of treatment include:

  • Behavioral modifications: such as urinating on a schedule, relaxation techniques, and using bathroom stalls instead of urinals.
  • Graduated exposure therapy – a step-by-step program that involves deliberately trying to urinate in increasingly more difficult places. About eight people out of every 10 with paruresis are helped by graduated exposure therapy.
  • Many patients can be taught self-catheterization (inserting a small tube into the urethra) which immediately allows the bladder to be emptied.
  • Some patients with paruresis benefit from the addition of drug therapy. Selective serotonin reuptake inhibitors (SSRIs) may help reduce anxiety levels which may allow graduated exposure therapy to be more effective.


Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.


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