Dear Doctors: Would you please devote a column to shy bladder syndrome? This embarrassing condition is a significant inconvenience to many men. In severe cases, it’s a life-altering disability. I suspect there are more sufferers out there than one would imagine, but shame keeps them quiet.

Dear Reader: Shy bladder syndrome is a social anxiety disorder that makes it difficult -- or even impossible -- for an individual to urinate when someone else is present. The medical term is paruresis. Drawn from ancient Greek, the word has its roots in the words “para,” which indicates something atypical or abnormal, and “uresis,” which refers to the act of voiding the bladder. The term was coined in 1952 by two physicians, who were the first to describe the condition in a paper they published in the Journal of General Psychology.

Shy bladder syndrome is a common form of social anxiety, and it is believed to be second only to fear of public speaking in terms of humans’ apprehensions. The exact number of people it affects is not known, but studies suggest up to a quarter of the population has experienced it to some degree. It is seen more often in males, which has been attributed to the public nature of men’s urinals. However, the condition occurs in people of all genders, and of all ages, including children and adolescents.

When someone has shy bladder syndrome, they avoid using bathrooms other than those in their own homes. The possibility that someone else could enter the bathroom, or even overhear them using the toilet, can trigger the condition.

Voluntary urination involves neurons located in a small region in the brainstem known as Barrington’s nucleus. They send signals via the spinal cord to the urinary sphincter, which is the ring of muscle that controls the flow of urine from the bladder. When someone chooses to urinate, those nerve impulses instruct the sphincter to relax.

When someone has shy bladder syndrome, something disrupts that cascade of messages. The result is the person’s sphincter fails to relax, and they are unable to pee. It’s easy to dismiss this as a minor annoyance. But for those living with the disorder, it can range from embarrassing to disruptive, and in some cases, to outright dangerous. Being unable to use a public restroom can interfere with activities of daily life, including work, social interactions, relationships and travel. A routine urine test during a medical appointment or for employment purposes becomes an ordeal. People with severe paruresis will often restrict how much they drink in order to avoid the need to use a bathroom.

Consistently failing to empty the bladder when needed can cause health complications, including urinary tract infections. It can also cause damage to the muscles of the bladder, which, ironically, can lead to urinary incontinence. The good news is that the condition can be treated. This includes the use of relaxation techniques to reduce anxiety, psychotherapy, anti-anxiety medications and cognitive behavior therapy. A systematic program of desensitization known as graduated exposure therapy has been found to be particularly helpful. In order to rule out a medical cause of difficulty urinating, it’s important to see a doctor for a definitive diagnosis.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: What happens in macular degeneration? My eye doctor found something called drusen in my eye, and now I’m supposed to take these special vitamins. He didn’t say anything about macular degeneration, but a co-worker scared me by saying drusen are the first sign of it.

Dear Reader: Macular degeneration, also known as age-related macular degeneration, is a disease in which damage to a certain part of the eye results in the loss of central vision. It typically begins to affect adults who are 55 and older, and risk increases with age. Macular degeneration is the leading cause of vision loss in older age. It doesn’t cause complete blindness, but the loss of central vision impairs the ability to read, drive, recognize faces and complete routine tasks. It can also interfere with day-to-day mobility.

To better understand the disease, we should begin with a bit of anatomy. The retina is a thin layer of light-sensitive cells in the back of the eye. It receives the light that enters the eye and sends that information to the brain for processing into images. Near the center of the retina is a small collection of cells, slightly less than a quarter-inch across, known as the macula. It contains a high concentration of photoreceptor cells that give us our central vision, most of our color vision, and that allow us to see fine detail. Our peripheral vision, which is everything outside of the central line of sight, is processed by the rest of the retina.

There are two types of macular degeneration -- wet and dry. The former develops due to an abnormal growth of blood vessels, which leak and cause scarring of the retina. It’s somewhat rare and occurs in less than 10% of cases. The majority of people develop dry macular degeneration, which is a gradual thinning of the macula. This brings us to drusen.

These are small white or yellowish deposits of debris that can form within the retina. Drusen are described as either hard or soft. Hard drusen, which have well-defined borders and are spread out, become common as people age. Soft drusen are larger, with indistinct borders, and tend to cluster together. Soft drusen, which can grow, can cause bleeding and scarring in the cells of the macula. An excess of drusen can contribute to developing macular degeneration. However, we want to reassure you that having drusen does not automatically mean you have macular degeneration.

A specialized combination of vitamins and minerals that were developed with data from AREDS 2, a large-scale study into eye diseases, has been found to reduce risk by 25%. These are available without a prescription at any drug store. You can also reduce risk by maintaining a heathy weight, getting regular exercise, not smoking, managing high blood pressure and cholesterol, and eating a healthy diet. This includes foods with omega-3 fatty acids, which may also help to reduce risk.

Now that you and your eye doctor are aware of the drusen, it’s important to continue to have regular eye exams in order to monitor them.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: My father passed away due to unexplained liver problems that we only now know was fatty liver disease. It’s 20 years later, and a CT scan shows some fat in my own liver. My liver readings are normal, but I’m the same age as my father was when his issues began. Should I be concerned?

Dear Reader: The term fatty liver disease refers to a range of liver disorders that are not caused by alcohol consumption, autoimmune disease, drug use or virus. It’s the most common liver disease in the U.S., and it is estimated to affect up to 30% of individuals. Once known as nonalcoholic fatty liver disease, the condition is now more accurately called metabolic-associated fatty liver disease, or MAFLD.

Your father’s health problems arose when this type of fatty liver disease was in the early stages of being understood. Although alcohol-induced changes to the liver were first described in the 1840s, it wasn’t until the 1980s that a metabolic cause for fatty liver disease began to emerge. A series of studies conducted throughout the decade revealed that metabolic abnormalities unrelated to alcohol use can also cause fatty liver disease. All these years later, with a clearer understanding of MAFLD, you are in a better position to understand and monitor the health of your own liver.

Fatty liver disease is just as it sounds -- an abnormal buildup of fat in the liver. While a healthy liver contains some fat, when the amount begins to exceed 5% to 10%, it is considered to be fatty liver disease. This excess fat triggers an inflammatory response that, over time, leads to liver damage. That means the liver’s hundreds of metabolic functions, which include filtering toxins, aiding in digestion, blood-sugar management, and creating and storing nutrients, are adversely affected. The condition is linked to being overweight or obese, high blood-lipid levels, high blood pressure and prediabetes and diabetes.

There is some evidence of a higher risk of developing MAFLD when the condition runs in a family. However, the lifestyle and environmental factors that we previously mentioned appear to play a more significant role.

The condition has few symptoms. Some people describe feeling tired, and some experience discomfort or pain in the upper right portion of the abdomen. This makes the disease challenging to diagnose. Abnormal results of liver-enzyme tests can be an indicator. So can a stiff or enlarged liver, as well as jaundice, which is a condition that causes the skin and the whites of the eyes to turn yellow.

When fatty liver disease is suspected, imaging tests may be used to assess the amount of fat in the liver. A biopsy to check for abnormal amounts of scar tissue in the liver, known as fibrosis, may also be requested.

It’s important that, going forward, you let your health care providers know you have a family history of fatty liver disease. Meanwhile, you can take steps to reduce your risk. These include staying away from alcohol, maintaining a healthy weight, choosing a healthful diet rich in fresh, plant-based foods, and getting regular exercise.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)