07/15/2026
Va**ng, Urinary Hesitancy, and One Important Question
A Clinical Reflection
Yesterday I was working with a client. She’s a young woman who has just completed her first year of university. She described how she is experiencing urinary hesitancy: when she sits down to urinate, nothing comes out. This is happening when she is using public washrooms, and it is affecting her life. If she is in a building at the university where she can’t find a private washroom, she will walk to a different building. This is quite disruptive to her life.
It would be easy to see this as a purely mechanical problem. Increased pelvic floor muscle tension would be a reasonable hypothesis, leading to a treatment plan that includes relaxation strategies, pelvic floor retraining, and improving coordination with the surrounding musculature.
My treatment plan will eventually include all of these elements.
But I wanted to know why.
What exactly was scary about using a public washroom?
At first, she was unsure. She hadn’t really thought about it. Her fear was just there.
We discussed this for a while, and the story finally became clear: as a teenager in high school, she had developed an aversion to using the washroom. Students had begun using the washrooms as places to v**e. Whenever she would enter a washroom, groups of students would be there, va**ng. They would be unwelcoming, making faces as though she shouldn’t be there. Also, the air quality was unpleasant. So she stopped going there and learned to hold her urine.
She stopped using the public washroom at school. And now she has trouble using the public washroom anywhere.
Of course, urinary hesitancy has many possible causes, and a thorough assessment remains essential. In this case, understanding her history changed how I approached treatment.
For this client, part of her treatment plan will be to understand why her fear is happening, and help her gradually relearn that using a public washroom can be safe.
Pelvic floor dysfunction is not always just about muscles.
Sometimes the pelvic floor is responding to experiences, emotions, and patterns that were learned as a form of protection.
As clinicians, understanding why a symptom developed may be just as important as knowing how to treat it.
Photo by Aryasatya Rafa Prayitno on Unsplash
