Breath-Hold Technique for Paruresis: Step-by-Step Guide

The breath-hold technique is one of the most talked-about tools for shy bladder (paruresis). It’s simple, it’s free, and you can practice it anywhere without anyone noticing. Many people find it helps them start the flow in situations where they used to freeze. This guide walks you through it step by step.

This guide combines and updates our original two-part breath-hold series.

Safety first

Before you start, check with your doctor, especially if you have a heart or lung condition, high or low blood pressure, are pregnant, or have ever fainted. Shy bladder can occasionally be a sign of a medical problem, so it’s worth ruling that out too.

Stop and breathe normally if you feel dizzy, lightheaded or unwell.
Never practice while driving, swimming, or anywhere fainting could be dangerous.
Don’t push past what’s comfortable. The goal is calm, not strain.

How the breath-hold technique works

When you’re anxious, the muscles that control urination tighten up. Holding your breath after a partial exhale causes a gentle build-up of carbon dioxide, which many people find helps those muscles relax and lets the flow begin. It also gives your mind something to focus on other than the people around you.

It isn’t a magic switch, and it doesn’t work the same for everyone. It works best as one tool alongside graduated exposure practice, the approach doctors and therapists recommend most.

Step-by-step

Step 1: Practice holding your breath (days 1–7)

Start somewhere comfortable, like lying in bed or sitting on the couch.

Breathe in normally, then breathe out until your lungs feel about 20% full.
Hold your breath for 5 seconds, then breathe normally.
Gradually build up: 10 seconds, 15, 20, and so on, toward about 40 seconds.
Progress from lying down to sitting, then standing, then walking around.

You can practice almost anywhere, at your desk or watching TV, and nobody will notice. Make it a game. It may take a few days to a couple of weeks to get comfortable.

Step 2: Try it at home

Drink plenty of water and wait until you really need to go.
Stand or sit as you normally would. Take a normal breath, then exhale until about 20% of the air is left.
Hold your breath. After a while, many people notice a feeling of the “bottom dropping out” as the muscles relax and the flow starts.
Keep holding for a few seconds after the flow starts so it gets strong, then breathe normally.
If the stream stops, exhale, then hold again.

If your shy bladder is severe, you might practice with a trusted person nearby at home first.

Step 3: Take it into the real world, step by step

Now combine the technique with graduated exposure. Start with easier situations and work up:

A stall in a quiet public restroom
A stall in a busier restroom
For men: a urinal in an empty restroom, then with others present
Busy places, like airports, stadiums and concerts

Practice daily if you can, whether or not someone else is there.

Tips that help

Start early. You can begin the exhale-and-hold as you walk into the restroom, so you’re already relaxing by the time you’re in position.
Don’t panic if the flow stops. Someone walking in might interrupt it. Just exhale and hold again.
Nobody can tell. Holding your breath is invisible to everyone around you.
Be patient with yourself. Some days will be easier than others. That’s normal.

If the breath-hold technique doesn’t work for you

The breath-hold technique doesn’t help everyone, and that’s okay. If you’ve given it a fair try, focus on graduated exposure, and consider whether working with a therapist who specializes in anxiety is the right next step. If you have trouble urinating even when you’re alone, see a doctor. The Urology Care Foundation has a helpful overview of paruresis and its treatment options.

Go further with a complete program

The Paruresis Cure System by Dr. Anum Khan, MBBS, M.D., is a step-by-step, drug-free program for overcoming the anxiety behind shy bladder, at your own pace. Instant download, with a 30-day money-back guarantee.

See what’s inside the ebook →

This article is general information, not medical advice. Please read our medical disclaimer and talk to your doctor before trying breath-holding techniques.