Choking at the BowlWhy do men have trouble urinating at ballparks?

A Slate employee—we'll call him "Thad"—asks the sports department to solve a problem that has been vexing him: Why does he have trouble urinating at ballparks? His testimony, worded as delicately as possible, goes like this: At a Seattle Mariners game, Thad slugged down several ballpark beverages. Later, he shuffled into the restroom, angled toward the urinals, unzipped his trousers, and then … nothing. Not a drop. Embarrassed and in acute pain, he waddled back to his seat, where he spent the remaining innings swaying like Stevie Wonder in front of a piano.

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After polling some of the country's pre-eminent urologists, we discovered that, surprise, Thad isn't alone. Men experience stage fright at ballpark urinals all the time. In fact, the problem is so common that urologists have a reassuring, pat-on-the-butt-sounding name for it: choking at the bowl.

There are three reasons why ballparks cause men to choke—two physical, one psychological. First, some men spend their time at the ballpark slugging down a beer every half-inning. Alcohol causes the prostate gland to swell, which impedes the flow of urine from the bladder to the urinal channel. Thus, when the man reaches the urinal, nothing happens. Dr. Rodney Appell, a urologist at the Baylor College of Medicine in Houston, says the problem occurs most frequently with older men who have enlarged prostates to begin with.

Other times men choke at the bowl because they guzzle too many beverages, alcoholic or not, and overstretch their bladders. A normal-sized bladder will contract when full, allowing urine to flow out of the body. But an overstretched bladder—distended by four or five souvenir-cup sodas—is slow to contract, and sometimes urination stalls.

But most of the men who choke at the bowl suffer from an anxiety disorder called paruresis, or Shy Bladder Syndrome. These men, quite simply, are embarrassed to bare all in the presence of strangers. Steve Soifer, a professor of social work who founded the International Paruresis Association, estimates that 17 million Americans suffer from some form of Shy Bladder Syndrome, about 7 percent of the population.

When a man with a shy bladder enters the ballpark restroom, the crowds, long lines, and stadium noise make him sweat. So does the ballpark restroom's infamous trough urinal, a knee-high, stainless steel gutter that forces men to urinate while standing elbow-to-elbow. (Some stadiums built before the Trough Era have gutters carved directly into the floor.) If the shy bladder even makes it to the trough—some flee the restroom at this point—his nervousness causes him clamp down on his sphincter muscle, which prevents his bladder from contracting.

Soifer, a recovering paruretic himself, offers a three-day workshop for shy bladders, held monthly in cities in the United States, Canada, and Great Britain. It costs $300 to attend. The first day is a group counseling session. During the second day, attendees gorge themselves on water and then, in pairs, practice voiding in their hotel bathrooms. In this exercise, one man stands at the toilet while his partner stands a comfortable distance behind him. As the first man begins to urinate, his partner inches closer, eventually standing directly behind the man, sometimes touching or razzing him as he urinates, to re-create the feel of a busy public restroom. The closing event of the workshop, which Soifer calls the "graduation ceremony," is held in a bathroom at a train station, airport, or, occasionally, a ballpark.

Even with therapy, will a shy bladder ever feel at ease at the ballpark trough? "I've suffered from paruresis for 30 years," Soifer says, "and I've been in recovery for the last six. I'm not cured. It's a lot like alcoholism. You can recover close to 100 percent, but it can get set off again in certain situations. That's why I don't talk about a cure."

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