The bell rang for a long time before Zhang, a sophomore in high school, ran into the classroom awkwardly. It turned out that before class, he already felt his belly was full, but after squatting in the toilet for ten minutes during class, he did not discharge any urine. Recently, this strange condition has become more and more serious, he is even afraid to go to the toilet between classes. But people have three emergencies, so how can he listen to the lectures if he continues like this? So he came to the urology clinic and described his plight to Dr. Li, who saw him. Doctor: Can you describe the onset of your condition? Xiao Zhang: This condition has been around for several years. When standing up to urinate, if there is someone next to me, it is particularly difficult to urinate. In the case of squatting, it is very painful to urinate. In recent months, the situation has become very serious, when there are people in the toilet, even squatting pits can not urinate normally. Because the toilets at school are full of people between classes, I often have to hold it for the whole morning. What is this all about? Doctor: If there is no one next to you when you go to the toilet, will this still happen? Xiao Zhang: If you urinate in the bathroom at home, then generally no such problem occurs. In the mall toilet when there are few people can also be normal urine, when there are many people will be the same as in school. The doctor thought about it and said: The problem you have may be a psychogenic urinary difficulty. This is not an organic disease, but a psychological disorder, mostly seen in young men. You do not have an organ disorder per se, but to be cautious you should also have a urinary flow rate test. Zhang: Why do I try so hard to urinate but can’t? Doctor: In order to control urination, a part of the body’s muscle closes the urethra like a gate, this part of the muscle is called the “sphincter”, only when this part of the muscle is relaxed, the urethra will be open. Normal people’s sphincter will relax when urinating, but in the case of mental tension, the sphincter will not relax, equivalent to the gate can not be opened, and the more tension the more can not open. This is the reason why mental urination is difficult. Zhang: Why do I feel painful to urinate when I squat? Dr. Li: This condition is called abdominal pressure-assisted urination. Squatting raises the pressure in the abdominal cavity, and this pressure is transmitted to the bladder, making the pressure in the bladder higher, so that urination becomes easier. Abdominal pressure-assisted urination is actually an incorrect urination habit because abdominal pressure is also transmitted to other organs. In the long run, you will be prone to hemorrhoids, hernias, varicose veins and other diseases. This incorrect urination habit should be avoided. Xiao Zhang: How is the urine flow rate test you mentioned done? Does it hurt? Doctor: The urine flow rate test is a very simple test that is completely non-invasive to the body. All you need to do is to want to urinate in a special container, the container can calculate your urination rate per second, at the end of urination will automatically be drawn into a curve. A normal male urination curve is like a smooth parabola with a maximum urine flow rate greater than 15 ml/sec. If the maximum urine flow rate is less than 15 ml/sec or does not appear smooth, there may be a problem. Zhang: If there is a problem with the urine flow rate, what does it mean? Doctor: Abnormal urine flow rate indicates the presence of organic disease. To use a simple analogy, the firefighting high-pressure water gun can spray water, there are two necessary conditions, one is the pipe, one is the pump. If the hose is blocked, or the pump does not work, neither can spray water. The process of urination is very similar, the urethra is equivalent to the tube, the bladder is equivalent to the pump. A problem with the bladder or urethra will be reflected in the urine flow rate. But the urine flow rate is only a simple initial screening tool, and further tests are needed to know what the exact cause is. After the urine flow rate test showed that it was completely normal, Zhang came back to ask: What should I do now? Doctor: Psychogenic dyspareunia is a psychological problem, the onset of which mostly has a bad psychological basis such as low self-esteem and shyness, and has a high level of stress in the recent past. So first of all, we should carefully analyze our recent psychology and do “self-decompression”. In addition, you can use some behavioral correction methods, such as every time you urinate should be in the toilet only after the urge to urinate, resulting in the situation that you have to go in to urinate. If there is someone next to you, take the initiative to divert attention or take deep breaths and count, which can reduce the nervous reaction. If you have the conditions, you can do it first in a toilet that is not crowded, and then transition to a toilet with more people. If you keep doing this, you will gradually establish good urination habits and overcome this problem. If after a period of time there is still no improvement, formal psychotherapy should be carried out under the guidance of a psychologist. After carefully analyzing his situation, Zhang found that he was under too much pressure from his recent studies. He followed Dr. Li’s method and now he has basically recovered and no longer has to be afraid to go to the toilet between classes!