Anxiety about having a bowel movement or bowel discomfort syndrome: These are all terms for what is medically called parcopresis, or difficulty having a bowel movement when you’re not at home. The Germans gave this condition a name: Heimscheißer (pronounced “heimscheisser”), meaning “house shit.”
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Those who suffer from this disorder feel distress and anxiety about going to the bathroom at school, work, or any public place. Some may even have difficulty having a bowel movement during the holidays.
If forced to use a toilet outside the home, patients may experience palpitations, excessive sweating, nausea, tremors, and difficulty having a bowel movement.
People with bowel movement anxiety sometimes eat less or even avoid certain social activities that could expose them to the need to use public restrooms.
Anxiety related to defecation appears to be quite common. A study of 714 Australian university students found that just over 14% avoided public toilets due to anxiety-related concerns. Another 3% avoided public toilets for fear of contamination.
Bowel anxiety is often triggered by an overwhelming fear of being judged. Another study of 316 Australian university students found that the most common reason for this anxiety was fear of being perceived negatively because of their bowel movements. For example, people worried that others would think they were taking too long to have a bowel movement or worried about the sounds and smells made during the process.
Psychologists consider bowel movement anxiety a type of social anxiety disorder. Research shows that affected people tend to have negative thoughts about themselves, such as “if I fail at my job, then I am a failure as a person.”
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Ultimately, people with bowel movement anxiety are afraid of being judged by others.
What are the dangers of bowel movement anxiety?
Holding in stools can make them harder and drier in the colon because they absorb more water. This can lead to chronic constipation problems.
Chronic constipation increases the risk of problems such as:
- Bleeding from hemorrhoids
- Pain caused by an anal fissure (tearing of the lining of the anus) and
- Rectal prolapse (when part of the colon slips through the anus).
Over time, this can lead to fecal incontinence.
A surprising case from the United Kingdom describes a teenage girl who reportedly had such a phobia of going to the toilet that she often held in her stools for up to two months.
This led to a massive buildup of fecal matter in his colon, which eventually compressed his chest cavity. As a result, she suffered a heart attack and sadly died at the age of 16.
Education on correct use of the bathroom
Proper education about toileting behavior is part of the treatment for bowel movement anxiety.
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For example, the time you spend in the toilet is important. A Turkish study found that spending more than five minutes in the toilet was associated with hemorrhoids and anal fissures. People with bowel movement anxiety are more likely to experience these constipation complications, which can make the anxiety even worse.
Getting enough dietary fiber can help because it softens stools and makes them easier to pass. This can reduce discomfort during defecation.
In Australia, the minimum daily recommendation for dietary fiber is 30 grams for adult men and 25 grams for adult women.
A useful practice for healthy and regular bowel movements that I recommend to my patients is the “SEN” technique:
- Maximum time spent in the toilet: six minutes
- Enough fiber (consume more fruits and vegetables and whole grains)
- Do not force when evacuating (it should come out relatively easily).
It’s also important to stay hydrated and be careful of medications like opioids, which can make constipation worse.
It is important for people with bowel movement anxiety to be aware of proper toilet behavior, as these people can become overly obsessed with their bowel movements. This may lead them to fail to adopt basic lifestyle measures that could actually make evacuation easier in general.
Cognitive behavioral therapy is recommended as a first-line treatment for people with bowel movement anxiety. This can help identify and manage negative thought patterns.
Often people take a gradual exposure approach. It is a structured, step-by-step process in which the person concerned is confronted with increasingly difficult situations in public toilets in order to reduce anxiety and increase confidence.
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The most important thing to overcome bowel movement anxiety is to seek help from a qualified healthcare professional.
Start by talking to your doctor, who can assess whether your symptoms are likely caused by bowel movement anxiety or another more serious digestive problem. He or she may prescribe medications to help relieve constipation.
Your GP may also refer you to a psychologist, who can offer cognitive behavioral therapy to help you change negative thought patterns.
Frequently holding stools is not good for your health. If you’re feeling stressed about having to vent at work, school, or while traveling, it’s worth taking the time to understand why and fix the problem.
* Vicente Ho is an academic clinical gastroenterologist and associate professor at the University of Western Sydney
*This article is republished from The Conversation under a Creative Commons license. Read the original.
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