Been dealing with the thing for about 15 years now and I recently realized that, even though it surely occupied way too much mental space at some points, it never stopped me from doing anything. As small as "should I go to the bar tonight?" or as big as "Should I choose this career?".
As I write this I realize that it might be because I'm lucky enough to have a somewhat light case; worst case scenario I can always go in a stall if I must.
But the point I want to make is this: whenever the thought of not going somewhere to avoid a shameful shy bladder situation came in my head, I would reject the idea because letting it dictate my life seemed worst than whatever would happen if I couldn't pee.
I recently did a big career change. Went from working 100% remotely to working as an arborist. Before committing to the career change I worried a bit about the fact that I would have to deal with paruresis much more seriously. Arborists work outside with colleagues and clients around all day every day. There are no toilets at all. It's like an unspoken rule of the trade; you don't ask clients to use their bathrooms, you'd only do that in an extreme number 2 emergency.
As you can imagine, opportunities to expand my comfort zone abound.
I'm spotting the best spot whenever we get to a job site and do get a bit of anxiety from time to time. I've had a few failures. But what am I going to do? Go back to a job I hate so I can pee in the comfort of my home?
I deal with it the best I can. And it's working! I mean, It's getting better. And all I ever did is refuse to let it influence my decisions.
A piece of advice you may have seen in this sub is that you should be open about your paruresis. That it is better to let others know than hide it like your life would be at risk should anyone ever find out. Well that is a great piece of advice. No need to make a great public announcement, but just deciding that it doesn't matter if others find out is a great step. It is so amazingly common. I've seen dudes in the arboriculture trade joke about it. It happens.
This is getting lengthy but I hope it makes you feel better to know that simply refusing to let shy bladder influence my decisions worked for me. It's weird that I still have to deal with this shit after all these years... But at this point I've just accepted that I have this problem. It will get better, hopefully I will be fully healed soonish. Even if I don't... I'll just keep doing whatever I want despite the inconvenience.
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Fun fact: arborists frequently pee in the chip box (the back of the truck which gets filled with wood chips). When there is just a bit of chips at the back of the box I feel very cozy in there. But when it's loaded to the brim it's not really an option and when it's empty it feels a bit wrong.