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.

It has been a long winter, filled with many viruses and cost-of-living pressures, on top of the usual mix of work, study, life admin and caring responsibilities.

Stress is an inevitable part of life. In short bursts, our stress response has evolved as a survival mechanism to help us be more alert in fight or flight situations.

But when stress is chronic, it weakens the immune system and makes us more vulnerable to illnesses such as the common cold, flu and COVID.

Stress makes it harder to fight off viruses

When the immune system starts to break down, a virus that would normally have been under control starts to flourish.

Once you begin to feel sick, the stress response rises, making it harder for the immune system to fight off the disease. You may be sick more often and for longer periods of time, without enough immune cells primed and ready to fight.

In the 1990s, American psychology professor Sheldon Cohen and his colleagues conducted a number of studies where healthy people were exposed to an upper respiratory infection, through drops of virus placed directly into their nose.

These participants were then quarantined in a hotel and monitored closely to determine who became ill.

One of the most important factors predicting who got sick was prolonged psychological stress.

Cortisol suppresses immunity

“Short-term stress” is stress that lasts for a period of minutes to hours, while “chronic stress” persists for several hours per day for weeks or months.

When faced with a perceived threat, psychological or physical, the hypothalamus region of the brain sets off an alarm system. This signals the release of a surge of hormones, including adrenaline and cortisol.

In a typical stress response, cortisol levels quickly increase when stress occurs, and then rapidly drop back to normal once the stress has subsided. In the short term, cortisol suppresses inflammation, to ensure the body has enough energy available to respond to an immediate threat.

But in the longer term, chronic stress can be harmful. A Harvard University study from 2022 showed that people suffering from psychological distress in the lead up to their COVID infection had a greater chance of experiencing long COVID. They classified this distress as depression, probable anxiety, perceived stress, worry about COVID and loneliness.

Those suffering distress had close to a 50% greater risk of long COVID compared to other participants. Cortisol has been shown to be high in the most severe cases of COVID.

Stress causes inflammation

Inflammation is a short-term reaction to an injury or infection. It is responsible for trafficking immune cells in your body so the right cells are present in the right locations at the right times and at the right levels.

The immune cells also store a memory of that threat to respond faster and more effectively the next time.

Initially, circulating immune cells detect and flock to the site of infection. Messenger proteins, known as pro-inflammatory cytokines, are released by immune cells, to signal the danger and recruit help, and our immune system responds to neutralise the threat.

During this response to the infection, if the immune system produces too much of these inflammatory chemicals, it can trigger symptoms such as nasal congestion and runny nose.

What about chronic stress?

Chronic stress causes persistently high cortisol secretion, which remains high even in the absence of an immediate stressor.

The immune system becomes desensitised and unresponsive to this cortisol suppression, increasing low-grade “silent” inflammation and the production of pro-inflammatory cytokines (the messenger proteins).

Immune cells become exhausted and start to malfunction. The body loses the ability to turn down the inflammatory response.

Over time, the immune system changes the way it responds by reprogramming to a “low surveillance mode”. The immune system misses early opportunities to destroy threats, and the process of recovery can take longer.

So how can you manage your stress?

We can actively strengthen our immunity and natural defences by managing our stress levels. Rather than letting stress build up, try to address it early and frequently by:

1) Getting enough sleep

Getting enough sleep reduces cortisol levels and inflammation. During sleep, the immune system releases cytokines, which help fight infections and inflammation.

2) Taking regular exercise

Exercising helps the lymphatic system (which balances bodily fluids as part of the immune system) circulate and allows immune cells to monitor for threats, while sweating flushes toxins. Physical activity also lowers stress hormone levels through the release of positive brain signals.

3) Eating a healthy diet

Ensuring your diet contains enough nutrients – such as the B vitamins, and the full breadth of minerals like magnesium, iron and zinc – during times of stress has a positive impact on overall stress levels. Staying hydrated helps the body to flush out toxins.

4) Socialising and practising meditation or mindfulness

These activities increase endorphins and serotonin, which improve mood and have anti-inflammatory effects. Breathing exercises and meditation stimulate the parasympathetic nervous system, which calms down our stress responses so we can “reset” and reduce cortisol levels.

Sathana Dushyanthen, Academic Specialist & Lecturer in Cancer Sciences & Digital Health| Superstar of STEM| Science Communicator, The University of Melbourne

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