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.

Picture two people, both suffering from a serious mental illness requiring hospital admission. One was born in Australia, the other in Asia.

Hopefully, both could be treated on a voluntary basis, taking into account their individual needs, preferences and capacity to consent. If not, you might imagine they should be equally likely to receive treatment against their will (known colloquially as being “sectioned” or “scheduled”).

However, our research published in British Journal of Psychiatry Open suggests this is not the case.

In the largest study globally of its kind, we found Australians are more likely to be treated in hospital for their acute mental illness against their will if they are born overseas, speak a language other than English or are unemployed.

What we did and what we found

We examined more than 166,000 episodes of voluntary and involuntary psychiatric care in New South Wales public hospitals between 2016 and 2021. Most admissions (54%) included at least one day of involuntary care.

Being brought to hospital via legal means, such as by police or via a court order, was strongly linked to involuntary treatment.

While our study does not show why this is the case, it may be due to mental health laws. In NSW, which has similar laws to most jurisdictions in Australia, doctors may treat a person on an involuntary basis if they present with certain symptoms indicating serious mental illness (such as hallucinations and delusions) which cause them to require protection from serious harm, and there is no other less-restrictive care available. Someone who has been brought to hospital by police or the courts may be more likely to meet the legal requirement of requiring protection from serious harm.

The likelihood of involuntary care was also linked to someone’s diagnosis. A person with psychosis or organic brain diseases, such as dementia and delirium, were about four times as likely to be admitted involuntarily compared to someone with anxiety or adjustment disorders (conditions involving a severe reaction to stressors).

However, our data suggest non-clinical factors contribute to the decision to impose involuntary care.

Compared with people born in Australia, we found people born in Asia were 42% more likely to be treated involuntarily.

People born in Africa or the Middle East were 32% more likely to be treated this way.

Overall, people who spoke a language other than English were 11% more likely to receive involuntary treatment compared to those who spoke English as their first language.

Some international researchers have suggested higher rates of involuntary treatment seen in people born overseas might be due to higher rates of psychotic illness. But our research found a link between higher rates of involuntary care in people born overseas or who don’t speak English regardless of their diagnosis.

We don’t know why this is happening. It is likely to reflect a complex interplay of factors about both the people receiving treatment and the way services are provided to them.

People less likely to be treated involuntarily included those who hold private health insurance, and those referred through a community health centre or outpatients unit.

Our findings are in line with international studies. These show higher rates of involuntary treatment among people from Black and ethnic minority groups, and people living in areas of higher socioeconomic disadvantage.

A last resort? Or should we ban it?

Both the NSW and Australian mental health commissions have called involuntary psychiatric care an avoidable harm that should only be used as a last resort.

Despite this, one study found Australia’s rate of involuntary admissions has increased by 3.4% per year and it has one of the highest rates of involuntary admissions in the world.

Involuntary psychiatric treatment is also under increasing scrutiny globally.

When Australia signed up to the UN Convention on the Rights of Persons with Disabilities, it added a declaration noting it would allow for involuntary treatment of people with mental illness where such treatments are “necessary, as a last resort and subject to safeguards”.

However, the UN has rejected this, saying it is a fundamental human right “to be free from involuntary detention in a mental health facility and not to be forced to undergo mental health treatment”.

Others question if involuntary treatment could ever be removed entirely.

Where to from here?

Our research not only highlights concerns regarding how involuntary psychiatric treatment is implemented, it’s a first step towards decreasing its use. Without understanding how and when it is used it will be difficult to create effective interventions to reduce it.

But Australia is still a long way from significantly reducing involuntary treatment.

We need to provide more care options outside hospital, ones accessible to all Australians, including those born overseas, who don’t speak English, or who come from disadvantaged communities. This includes intervening early enough that people are supported to not become so unwell they end up being referred for treatment via police or the criminal justice system.

More broadly, we need to do more to reduce stigma surrounding mental illness and to ensure poverty and discrimination are tackled to help prevent more people becoming unwell in the first place.

Our study also shows we need to do more to respect the autonomy of someone with serious mental illness to choose if they are treated. That’s whether they are in NSW or other jurisdictions.

And legal reform is required to ensure more states and territories more fully reflect the principal that people who have the capacity to make such decisions should have the right to decline mental health treatment in the same way they would any other health care.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Amy Corderoy, Medical doctor and PhD candidate studying involuntary psychiatric treatment, School of Psychiatry, UNSW Sydney

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