Q: What is the breath-holding technique? Does it work for everyone?

A: This technique is thought to work because an increase in carbon dioxide in the bloodstream has been reported to reduce anxiety and induce relaxation in some patients. This technique is well suited for people who can usually urinate around others once they get a stream started, but have difficulty starting the stream.  Monroe Weil, Ph.D. reported using it successfully in three patients.[xi] A brief description of the technique follows.

1. Discuss this technique with your physician first before using it.  Even after getting an OK from your doctor, if you experience any kind of abnormal reaction be sure to let your doctor know before proceeding any further with this technique.  Before attempting to use breath holding in a restroom, practice holding your breath.  Start out holding for 10 seconds, then 15, increasing the time in gradual increments.  Practice often in different settings. Pay attention to your body’s response to holding your breath. If you are feeling anxiety or panic while not in a restroom, you’ll need to do more practice. Since the issue we’re dealing with is anxiety while urinating, it won’t be productive to do something in a restroom that is increasing your fear. When you can hold your breath for 45 seconds and feel calm during the process, you are ready.
   
   
2. Your first attempt should be in a place where you can feel comfortable, such as at home or an empty public restroom, so that you can be free of distractions or anxiety triggers. If the technique is working you will experience it in a variety of ways. Some describe it as the "pelvic floor dropping", or an unstoppable relaxation of the urinary sphincter muscle; others say it will make you feel temporarily incontinent. Your level of urgency should be moderate to strong, but not extreme. 
   
   Take your position either in the stall or urinal, breathe normally, and then exhale about 75% of your breath. Do not take in a big gasp of air before exhaling. You’ll have too much oxygen in your lungs and it will blunt the effect. It’s also important to not exhale completely. There needs to be some air left in the lungs. When holding your breath, pinch your nose if you have to. After about 45 seconds you should experience the pelvic floor "drop" and your stream will start.  Once the stream starts if you start clamping up just exhale again and your stream will return. If your lungs are empty, you may need to take in a small breath and then resume holding it.
   
   
3. If you find the technique helps you start urinating, with practice it will work at any level of urgency, in every place.  Continue practicing and eventually it should be possible to reduce the time required to start urinating.  Some people start holding their breath as they approach the restroom so the time required at a urinal or stall is reduced accordingly.
   
   
4. Some people using the technique report that it works best if a person has a low level of anxiety in the restroom. A period of graduated exposure and support group work may be needed to reduce the level of fear in a public restroom to the point where the technique begins to work. So if you are trying it and not getting any results, continue with your recovery program and try it again a few months down the road. The amount of reduction of the tension in the bladder neck and sphincter provided by breath holding may only be enough to offset a certain level of anxious tension in those areas. If a person is freaking out in the restroom, no amount of breath holding might work.

Some additional notes on breath holding:

If you find the technique useful, after practice it will work even with a low level of urgency or none at all.  At this point if it is necessary to empty the bladder in a crowded situation, before a trip, or to avoid waking up at night, breath holding works every time.

During the practice period, some people who reported a great deal of fear holding the breath for a long time have persisted and found that the desired effect on easing urination happens once they overcome the fear. If this applies to you, try to stay with the practice and get past the fear. Many believe they will faint if they hold their breath for too long, but that is not a serious danger. If you have the level of control to starve yourself of air to the point of fainting, once you faint you’ll start breathing again. If you’re very concerned, then try holding your breath at a doctor’s office where emergency help is available. Most people report they can urinate after around 45 to 60 seconds of breath holding. That’s a long time, but if you are healthy it’s not dangerously long.

There is one side effect of the technique, which is that it can also relax the anal sphincter. So if a person needs to deal with that, visit a stall and take care of #2 before practicing at urinals.

Below is a personal account from someone who has tried this technique and uses it successfully:

This would not be complete w/o a sports analogy. When I first started skiing really steep slopes, almost extreme terrain, I was with a group of very good skiers. I'm a good black diamond, mogul skier and these folks were way above that. Our ski instructor/guide told me that the only way I could get down the slope was to have courage. I had to trust my ability to slow my skis with all the techniques [I] had previously learned. You must have the courage to see this through. It is worth it, trust us! You will not faint or pass out but you probably will gasp for air, at that point you are close. Very close, stay with it. If you do gasp for air, just suck in a little and hold your breath again.

For those of us doing it properly it works every time in every condition.  For me troughs at Steeler games, planes, bars, everywhere. As a matter of fact sometimes I'm very tense just from holding my breath and being stiff or whatever, but I know if I see it through it works. Once the stream starts if you start clamping up just exhale again and your stream will return. For those of us practicing for years, usually once our stream starts we can keep it going.

Over time a lot more people will become comfortable with the technique. Again, it does not improve your primary AP, although my secondary AP is almost non-existent. I find myself making plans and doing things with people and places that I would have avoided. I'm not thinking about AP. Then later it dawns on me "oh my gosh, I just decided to go to such and such with so and so w/o thinking about where I'm going to pee.  Pretty Cool.

One warning about using this technique: In some individuals with panic disorder, it has been reported that elevated levels of carbon dioxide can cause symptoms of increased anxiety and panic. If you notice this happening and the symptoms do not improve with practice, then the technique may not be useful for you, or won’t become useful unless the panic disorder is treated.