For most people, the daily or near-daily ritual of having a bowel motion is not something we give a great deal of thought to. But for some people, the need to do a “number two” in a public toilet or at work can be beset with significant stress and anxiety.

In recognition of the discomfort people may feel around passing a bowel motion at work, the Queensland Department of Health recently launched a social media campaign with the message “It’s okay to poo at work”.

The campaign has gained significant traction on Instagram and Facebook. It has been praised by health and marketing experts for its humorous handling of a taboo topic.

A colourful Instagram post is accompanied by a caption warning of the health risks of “holding it in”, including haemorrhoids and other gastrointestinal problems. The caption also notes:

If you find it extremely difficult to poo around other people, you might have parcopresis.

What is parcopresis?

Parcopresis, sometimes called “shy bowel”, occurs when people experience a difficulty or inability to poo in public toilets due to fear of perceived scrutiny by others.

People with parcopresis may find it difficult to go to the toilet in public places such as shopping centres, restaurants, at work or at school, or even at home when friends or family are around.

They may fear being judged by others about unpleasant smells or sounds when they have a bowel motion, or how long they take to go, for example.

Living with a gastrointestinal condition (at least four in ten Australians do) may contribute to parcopresis due to anxiety about the need to use a toilet frequently, and perceived judgment from others when doing so. Other factors, such as past negative experiences or accessibility challenges, may also play a role.

For sufferers, anxiety can present in the form of a faster heart rate, rapid breathing, sweating, muscle tension, blushing, nausea, trembling, or a combination of these symptoms. They may experience ongoing worry about situations where they may need to use a public toilet.

Living with parcopresis can affect multiple domains of life and quality of life overall. For example, sufferers may have difficulties relating to employment, relationships and social life. They might avoid travelling or attending certain events because of their symptoms.

How common is parcopresis?

We don’t really know how common parcopresis is, partly due to the difficulty of evaluating this behaviour. It’s not necessarily easy or appropriate to follow people around to track whether they use or avoid public toilets (and their reasons if they do). Also, observing individual bathroom activities may alter the person’s behaviour.

I conducted a study to try to better understand how common parcopresis is. The study involved 714 university students. I asked participants to respond to a series of vignettes, or scenarios.

In each vignette participants were advised they were at a local shopping centre and they needed to have a bowel motion. In the vignettes, the bathrooms (which had been recently cleaned) had configurations of either two or three toilet stalls. Each vignette differed by the configuration of stalls available.

The rate of avoidance was just over 14% overall. But participants were more likely to avoid using the toilet when the other stalls were occupied.

Around 10% avoided going when all toilets were available. This rose to around 25% when only the middle of three toilets was available. Men were significantly less likely to avoid going than women across all vignettes.

For those who avoided the toilet, many either said they would go home to poo, use an available disabled toilet, or come back when the bathroom was empty.

Parcopresis at work

In occupational settings, the rates of anxiety about using shared bathrooms may well be higher for a few reasons.

For example, people may feel more self-conscious about their bodily functions being heard or noticed by colleagues, compared to strangers in a public toilet.

People may also experience guilt, shame and fear about being judged by colleagues or supervisors if they need to make extended or frequent visits to the bathroom. This may particularly apply to people with a gastrointestinal condition.

Reducing restroom anxiety

Using a public toilet can understandably cause some anxiety or be unpleasant. But for a small minority of people it can be a real problem, causing severe distress and affecting their ability to engage in activities of daily living.

If doing a poo in a toilet at work or another public setting causes you anxiety, be kind to yourself. A number of strategies might help:

• identify and challenge negative thoughts about using public toilets and remind yourself that using the bathroom is normal, and that most people are not paying attention to others in the toilets
• try to manage stress through relaxation techniques such as deep breathing and progressive muscle relaxation, which involves tensing and relaxing different muscles around the body
• engaging in gradual exposure can be helpful, which means visiting public toilets at different times and locations, so you can develop greater confidence in using them
• use grounding or distraction techniques while going to the toilet. These might include listening to music, watching something on your phone, or focusing on your breathing.

If you feel parcopresis is having a significant impact on your life, talk to your GP or a psychologist who can help identify appropriate approaches to treatment. This might include cognitive behavioural therapy.

Simon Robert Knowles, Associate Professor and Clinical Psychologist, Swinburne University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

When most people think about “healthy eating”, they usually focus on what they eat. That might mean trying to eat more fruit and vegetables or less fast food, or counting calories.

But there’s a lot more to healthy eating than just dietary intake. Behaviours and attitudes around food are also important.

Take, for example, orthorexia nervosa, which is an obsessive preoccupation with consuming only “healthy” foods. If healthy eating only means ingesting healthy foods, then people with orthorexia are super healthy.

But people who live with this eating disorder often struggle with relationships and report poor quality of life, among other issues.

Research suggests that shifting the focus from food itself to our experience of eating can have a range of health benefits. Let’s take a look.

Why are we so obsessed with diet?

Equating “healthy eating” with “healthy diet” may have taken off in the early 1980s with panic over the “obesity epidemic” in Western countries – defined as a rapid rise in the prevalence of people in the population with a body mass index (BMI) of 30 or greater.

But causes of obesity are complex and poorly understood, with numerous possible explanations beyond simply what a person eats. And admonishing overweight people to eat “healthier” has done nothing to reduce population rates of obesity.

There is some evidence that this fixation on weight has resulted in increased rates of disordered eating and eating disorders – both of which involve problematic eating behaviours and distorted attitudes towards food, weight, shape and appearance.

Clearly, something needs to change in how we think about healthy eating.

Listening to your body

A growing body of research on intuitive eating has found this approach has an array of health benefits.

Intuitive eating means trusting internal body cues that tell us when, what and how much to eat. For example, tuning into your stomach growling telling you it’s time to eat, or noticing feeling full or satisfied, or that you may crave certain foods because your body wants specific nutrients (such as protein after exercising).

Studies have shown this approach can lead to better physical and mental health as well as better diet quality, and is associated with lower BMIs.

Research also shows eating at regular intervals and eating with other people also lead to better overall health and diet.

But if you find it hard, you’re not alone

Most of us are surrounded by food environments that make healthy eating difficult.

Unhealthy food environments promote overeating and encourage us to override our innate signals of hunger and fullness.

When we’re surrounded by cheap and accessible sugary snacks, fast foods and large portions – and lots of marketing – it can be hard to develop a positive relationship with food.

The issue is particularly acute for people in more disadvantaged communities.

For example, in our research with rural Australians about food and eating, most told us they wanted to eat more healthily, but found it difficult for many reasons, These included busy schedules and the cost of healthier food.

Habits and emotional eating can also make healthy eating difficult.

So, what works?

For most people, healthy behaviours and attitudes to eating mean a balanced, flexible and non-judgmental approach, without fear of “bad” foods. It means paying attention to hunger and fullness cues.

But it also means recognising that food is a source of social and cultural connection. A healthy attitude to food doesn’t ignore nutritional information – it incorporates this knowledge into a broader and more joyous approach to eating.

Here are three suggestions to get you started.

1. Recognising signs of hunger and fullness

These may differ from person to person. Can you hear your stomach start to growl or your energy begin to dip? Is it a while since you ate? And while eating, is there a point where the hunger has gone away and you no longer feel a strong desire to continue eating? Some people find using hunger and fullness scales useful.

2. Reframing “bad” foods

Is there a food you really like but don’t eat because you consider it “bad” or “forbidden”? Try incorporating a small amount into your next meal or snack. You may find that doing so brings greater joy to your eating while simultaneously taking away its power.

3. Eating with people

If you normally eat by yourself or “grab and go”, see if there’s a way to plan more time for meals and include other people – whether this is more family meals or group lunches with coworkers.

But some people have to follow a specific diet

People with medical conditions that require a particular type of diet – such as those with diabetes or coeliac disease – need to follow that advice. But they may still be able to have healthy behaviours and attitudes towards food even within these constraints.

For example, one 2020 study of people with type 2 diabetes found that more intuitive eaters had better control of their blood sugar levels.

The bottom line

So – if you don’t have a medical condition that prevents it – go ahead and have some of that birthday cake. And then listen to your body when it tells you you’ve had enough.

If you feel that you have an unhealthy relationship with food that is interfering with your life, please contact your GP to discuss your options. You may also want to contact the Butterfly Foundation for support.

Nina Van Dyke, Associate Professor and Associate Director, Mitchell Institute, Victoria University and Rosemary V. Calder, Professor, Health Policy, Victoria University

This article is republished from The Conversation under a Creative Commons license. Read the original article.