You’re dining out with your co-workers at a well-respected restaurant. You’ve worn that elegant, neat suit you had bought for such occasions. Your colleagues’ attires, expensive perfumes and graceful manners say it all: this is a formal, sophisticated outing. You see your boss raising a glass full of red wine to make a proposal and you prepare yourself to join in, when suddenly, your colon has decided it’s time to deliver the mail. And you’ve transformed into a Harry. Not the prince Harry (because, of course, princes don’t engage in such dirty, low-life activities such as pooping). Harry, that guy from ‘Dumb and Dumber’.
And as your bloating increases and you hold on your gas, you keep thinking: you don’t belong in this world of red wines and nice smells. How could a world like this accept such an uncouth, disgusting bodily function after all? No, you’re unexcused and you deserve to suffer in silence since you ate that whole plate of pasta earlier.
Eventually, the urge has become so mandatory, you decide to listen to it. But where to go? Your home is hours away and you can’t just damp a professional dining, let alone the fact that THEY WILL SUSPECT WHY YOU HAD TO LEAVE. So, the remaining option: use the public restroom of the restaurant.
But what if a co-worker decides to follow you? And how much time is considered normal in the bathroom? And will they be able to smell it on you after you’ve finished your business?
These are the usual thoughts that trouble a person facing the monster of all poop: Toilet Anxiety. Its comrades are probably constipation and diarrhea.
In fact, “toilet anxiety” or “toilet phobia” are such neat, fluffy terms to include all the paranoia that the act of moving your bowels entails. Well, other names do exist for it. Though I’m sure nobody actually uses words like “parcopresis”—the fear of pooping in public bathrooms—or “paruresis” —the fear of urinating in the near presence of others. Not in casual conversation, at least. Actually, most people don’t talk about their poop at all. It’s like the world of toilets is a parallel version of ‘Fight Club’. With the exception that we do keep the rule of not spreading the dirt.
And it is proved by a 1985 study called ‘Meanwhile Backstage: Public Bathrooms and the Interaction Order’ that researched behavioral patterns in public bathrooms. According to it, all conversation ceases between friends once they’ve entered the stalls. Strangers glance briefly at each other, acknowledging each other’s presence, and then enter a silent contract of completely ignoring each other’s existence. This behavior arises mainly from our need to reinforce the limited physical boundaries that exist in public toilets.
Mild cases of anxiety include running the faucet or constantly flushing the toilet to muffle sounds of plopping or—ahem—farts, using toilet seat covers and paper wipes to touch doorknobs, spraying “Poo-Pourri” to dispel the foul odors, and using the toilet at your home before you go outside. Exaggerations can be feeling like your urethra has frozen and you can’t physically pee, not leaving the house unless the place you’re headed to has a “safe toilet”, hand washing rituals to cleanse yourself of all germs, never booking vacations or never staying at a friend’s house too long, quitting jobs, never getting involved in long-term relationships, feeling uncomfortable whenever someone mentions the word ‘poop’ and these kind of extremes (which I no doubt found very useful).
All these samples of behavior can be related to specific psychological conditions associated with toilet phobia:
• Social Anxiety: worrying about the social boundaries of using a public toilet, which includes being aware that others might hear you or see you enter a stall.
• Agoraphobia: fears of having “an accident” or not finding a toilet soon enough.
• OCD and germ phobia: obsessive thoughts that you might get contaminated from public-used facilities.
Despite that toilet anxiety is the second most common social phobia, there is decreased public awareness on the matter. Either that is the case or people just refuse to acknowledge the problem due to its very nature. The United Kingdom National Phobic Society suggests that around four million people in the UK (around 6%) feel anxious when they have to urinate in public restrooms. The International Paruresis Association estimated that the number is 220 million worldwide. As for number two, no research to date has been conducted.
Even Oprah Winfrey, while serving on a Chicago jury in 2004, wouldn’t go to the bathroom unless her fellow jurors muffled the sounds with singing. (Spoiler: One of the songs they sang was Kumbaya.)
“I have patients who have gone all the way back home to use the bathroom. I have individuals who will wait until the bathroom is free before they can use it. I have people who have ‘secret’ bathrooms in their office buildings so their co-workers can’t hear or smell them in the bathroom,” said Dr. Frank J. Sileo, a New Jersey psychologist.
In the case of agoraphobia, “Loofree”, an anonymous patient explained to Katrina Lovell, professor of Mental Health at the University of Manchester, that going shopping alone requires no drinking beforehand and at least 20 visits to the toilet before venturing out. “Loofree” also mentioned that they experience panicked thoughts like “can’t, can’t, can’t”, feelings of guilt and embarrassment, and that though they can enter a cubicle, they can do nothing once they’re in there.
As far as OCD is concerned, Steven J. Seay, an Ph.D licensed psychologist, elaborates:
“Due to the fear of urine, feces, semen, or other bodily secretions, toileting behaviors can be especially distressing for individuals with health-related OCD. Individuals may use large amounts of toilet paper and will often wipe excessively, resulting in bleeding and skin abrasions. Because these behaviors may be repeated multiple times per day, it is often difficult for the skin in these areas to heal. Some individuals also make use of antiseptic cleansers that further damage or distress tissue. Other individuals make use of gloves or other skin barriers while toileting. In efforts to avoid inhaling feces or urine, some individuals hold their breaths or wear face masks while using the restroom, particularly when flushing the toilet.”
But is this germ phobia associated with public toilets truly justified?
Dr. Lisa Bernstein, assistant professor at Emory University School of Medicine, says, “They’re the same bugs we transmit shaking hands. People are more freaked out about restrooms, but the same thing applies anywhere in public.”
According to Charles Gerba, a microbiologist at the University of Arizona who has studied germ-infested environments for more than 20 years, the most likely place to nurture entire bacterial ecosystems in public restrooms is the floor and not the toilet seats, as most people fear. That’s mainly because of the care most of us take before we sit on it. “To my knowledge, no one has ever acquired an STD on the toilet seat – unless they were having sex on the toilet seat!” said Abigail Salyers, PhD, president of the American Society for Microbiology.
And yet, this also means that everything else is a party of bacteria. The sink, the faucet, the doorknobs. In fact, fecal and urinary germs shower the air and the surrounding surfaces when we flush the toilet (which is exactly why flushing the toilet while you’re sitting on it is not recommended). These germs can carry any fecal-borne ailments, such as: E. coli, norovirus, salmonella, or shigella. Philip Tierno, MD, director of clinical microbiology and diagnostic immunology at New York University Medical Center and Mt. Sinai Medical School, suggested that we should leave the stall immediately after we flush. According to him, “The greatest aerosol dispersal occurs not during the initial moments of the flush, but rather once most of the water has already left the bowl.”
So, bottom line: Yes, there are some really dangerous germs basking in public bathrooms. But if you wash your hands properly (a 20-second wash is recommended), avoid having open wounds come in direct contact with surfaces, and have a healthy immune system, you’ve got nothing to worry about. Your skin is sufficiently equipped to keep all harmful bacteria out.
How did this social phobia start anyway?
Society has taught us from a young age that having a bladder or colon accident in public is the ultimate humiliation, let alone our mother’s warnings to “never touch the toilet seat”, “never talk about poop or fart in the presence of visitors”, “clean after the mess” and generally keep it within the confines of the bathroom. Nick Haslam, author of Psychology in the Bathroom, explains that we attach “shame and secrecy” to the bathroom from a very early age, and that some of that is evolutionary.
Gender norms and social stereotypes have sewn themselves into the embroidery. The pressure on women to be feminine and pleasant has forced them to live pretending they don’t have a colon and invent subtle ways to convince other people (mainly of the opposite gender) of this lie as well. Because, of course, GIRLS DON’T POOP. The toilet etiquette among men forbids glancing at each other during pee sessions or choosing a urinal next to someone else, as it might be considered sexual harassment. A 1976 study showed that invasion of this rule can delay men’s urination.
This particular reaction is deeply rooted in homophobia. Sarah Moore, a senior lecturer at the Royal Holloway University of London’s Centre for Criminology and Sociology, says that it is not actually because they fear other gay men, but because the men themselves want to reinforce their non-gayness. That said, transgender people also fear using the bathroom of their true gender as they might get bullied, while using the bathroom of their birth gender can induce equal anxiety.
Gender norms are not the only to blame though. Size labels also play a definitive role in toilet phobia. As Rachel Crittenden put it, when fat kids fart in movies everyone looks disgusted, but when the hot guy does it, it is worth a round of applause. Anne Hathaway once told COSMOgirl! “Don’t be Cameron Diaz if you’re not Cameron Diaz. Cameron Diaz seems amazing — she’s funny, she’s sexy, and she’s one of those girls who can burp and fart and still look cute. I’m not one of them, and I’m pretty sure that most girls aren’t.”
Whoever the culprit is, toilet phobia is as real as it can get and when you’re faced with a sudden fecal urge in a public place, you only have two options: answer to Mother Nature’s call or, hold it in.
Unfortunately, the second option might produce even worse outcomes.
According to Neelam Misra, MD, a New York-based physician, “Voluntarily resisting the urge to move one’s bowels can wreak havoc on the rectum, large intestine, and the entire gastro-intestinal tract. The longer the stool sits in the large intestine, the greater the amount of water absorbed. This leads to dry, hard stools. The passing of these stools can cause pain, anal fissures, hemorrhoids, discomfort, or bloating. Furthermore, when feces collect in the rectal vault, the stretch receptors signal to the brain, which causes the urge to poop. If those signals are consistently ignored, the signals diminish.”
And registered dietician Deborah Malkoff-Cohen said: “Poop is a toxin, the longer the feces are in you, the greater the risk of the toxins from the stool to be reabsorbed in the body. Another danger of overriding your body’s natural response is that it may cause dysfunction in the sphincter muscles used for pushing.”
As modern science states it, our gut is our second brain. There’s an immediate connection between our central nervous system and the enteric nervous system. That’s why we might get “butterflies in our stomach” or have nauseous responses to big events in our lives. And that’s why chronic anxiety might damage our bowels permanently. Diseases like IBS (Irritable Bowel Syndrome), Crohn’s and ulcerative colitis are all sewn with stress.
It’s also one of the reasons vacation constipation is a worldwide thing. Although there are many physical reasons you can’t poop when you travel—including that changing environment can throw your gut bacteria off balance, sitting in planes for hours puts your digestive system into inertia, eating irregularly and altering time zones—voluntarily withholding your bowels is a large contributing factor.
“What happens is you go out on the road, and you get into an environment that’s not as safe. To go to the bathroom, humans have to allow their autonomic system — the autopilot of our body — to go into relax mode. It’s the only way that you can go to the bathroom. So when you leave the comfort of your home, you get into an uncomfortable situation where you just don’t ever relax,” says Dr. Mehmet Oz, Professor of Surgery at Columbia University.
There is, of course, treatment.
The most popular psychological practices are probably Cognitive Behavioral Therapy and Exposure Therapy. The first is a modern method with relatively high success. Its core notion is that people can control how they feel by choosing their thoughts. So thoughts like “I can’t poop in public” become “Everybody poops. It’s a natural bodily function” and thoughts like “Germs will infect me” become “Some germs are actually friendly for my gut.” The latter is basically grinding your teeth and exposing yourself to your fears.
However, because of the shame and embarrassment that is wound into the very nature of the problem, most people don’t seek one. And if you’re one of those, you should at least attempt to overcome the problem on your own.
Here are some useful tips:
1. Be prepared to cover your tracks. Carry your own soap, paper wipes and sample perfume sprays. Follow simple tasks, such as loading the bowl with toilet paper to muffle the sound. Flushing, as discussed above, is not healthy.
2. Help yourself relax. Choose the stall that makes you feel most comfortable, practice breathing techniques, bring in reading material or use your phone to distract you, focus on the liberating feeling of emptying your bladder or colon. (There’s actually a term for the pleasure that comes with excreting: Poo-phoria, that fuzzy lightheadedness you feel once you get rid of a large mass of stool. Hey, think positively: THAT thing is no longer inside you!)
3. Talk about it. Yes, it is actually better to tell your boyfriend. Ask a friend you trust to play music loudly while you’re at it.
4. Read poop success stories. Seriously, learning how other people dealt with the problem can help you relax and reevaluate things. Stories like this and this. And generally, read about poop. Bonus: Open letter to the person pooping quietly in the public bathroom stall next to me.
5. Remember that literally everyone – everyone – does it. Not just Prince Harry, but the Queen of England, too. Johnny Depp poops. Rihanna poops. The President poops. Your boss poops (and is probably going to have a glorious pee session after that whole glass of wine). It’s one of the most basic functions that characterizes our nature as humans. Embrace it!