You sit down in a public toilet cubicle and focus on the task at hand – and then it happens. Someone walks into the bathroom and your bowels lock up. You get stage fright, pull up your pants, flush and leave.
If this is a familiar scenario – whether you’re in a work toilet, public loo or even a bathroom in a house-share – you’re not alone. In fact, anxiety around pooing in a public space, known as parcopresis, is “surprisingly common”, says Dr Ben Disney, a consultant gastroenterologist at University Hospitals Coventry and Warwickshire.
While most people might not particularly like it, they’ll still go for a poo – but 5% simply cannot empty their bowels in public toilets at all, estimates Professor Nick Haslam, a psychologist and author of Psychology In The Bathroom.
People with parcopresis “will only pass a bowel movement in toilets that they consider to be safe and private”, and they might also avoid the need to wee in public loos, known as paruresis, which is thought to impact 7% of people.
This isn’t good for the body or the mind. Parcopresis is associated with stress, social anxiety, reduced quality of life, impaired relationships, difficulty managing jobs and, in some cases, fear of leaving the house, says Dr Disney.
And then there are the physical repercussions of putting it off. Ignoring that “urge” could lead to impairment of the defecation reflex, explains Dr Disney, which basically means the strength of that urge to go to the toilet could lessen, making it harder to know when you need a poo. “This, in turn, can impair rectal sensitivity and decrease sphincter strength which compounds the situation,” he adds. Ultimately, it can lead to constipation.
The scale of this issue is not to be sniffed at – a recent report by the Bowel Interest Group found constipation cost the NHS £162m in 2017-18, with 71,430 people in England admitted to hospital for it.
Where does this toilet anxiety come from?
There are shameful connotations surrounding our bowels that only serve to reinforce the poo taboo, says Prof Haslam. These can stem from negativity around germs and diseases – and, in turn, feed into why people might get anxious about going to the toilet in shared facilities. “There’s a level of disgust and concern about contamination,” he says. “A certain minority of people worry about picking up some sort of infection.”
Embarrassment over sounds and smells plays a part too, says Dr Disney. Culturally, we’re made to feel ashamed of farting and pooing – so when people walk into the bathroom and something makes a splashing noise, that shame can feel overbearing. This embarrassment also comes from time restraints – if you’re gone from your desk for longer than five minutes you might feel it’s fairly obvious to others why that might be. Likewise, if there’s only one shared toilet and you know people are waiting outside, it can cause panic.
It’s like a type of social anxiety, says Prof Haslam. “Just like some people have an intense fear of public speaking or being seen eating in public, it’s very much the same – they have this exaggerated or irritation fear that other people will form a negative evaluation of them if they observe them,” he says.
“They don’t want to be overheard, they don’t want to be witnessed, the idea of being noticed while pooing – even though intellectually we all acknowledge everyone does it – is quite upsetting to some people, specifically those who are very concerned about being scrutinised.”
Lucy Fuller, a psychotherapist and Counselling Directory member, suggests it could also be to do with our evolutionary process and our “need for safety”.
“As an animal instinct, going to the toilet is something that you have to do and you have to stop everything else to do it,” she says. “So it’s about feeling safe and like you’re not going to be attacked in anyway in order to go to the toilet.”
How can you get past it?
Can you overcome public poo anxiety? “There are things that can be done,” says Prof Haslam, “but whether people do them is another thing.”
There are practical ways to get over you worries. Fuller recommends organising your routine around places where you do feel safe going to the toilet – for example, find out if there is a single cubicle somewhere in your building you could make use of.
If this isn’t possible, try distraction techniques to reduce the anxiety around noises – flush the toilet before you go in or put tissue in the toilet bowl to lower the likelihood of making noise. And, for those worried about the smell that may linger afterwards, try a V.I.Poo toilet spray or Aesop’s fancier post-poo drops.
Of course, these habits may be easier to adopt if done gradually. “If you have someone with a very ingrained habit of avoiding public restrooms, one way to overcome that anxiety is to slowly introduce them to those situations and make them stay there until they relax,” Prof Hallam suggests.
“Is it really so terrible if someone does hear you fart or a plop of a poo hitting the water?”
But to target the problem at its core, it’s also about working through the thoughts you tell yourself when you’re in this situation – and challenging them. “Is it really so terrible if someone does hear you fart in the bathroom or hears a plop of a poo hitting the water?” says Haslam.
“People are often having these thoughts and getting anxious without really interrogating them or realising these are foolish things to be concerned about – especially given that nobody is going to see you because you’re behind a stall.”
Challenging these intrusive thoughts can often remove or reduce the anxiety, he says, as can challenging the avoidance. There are also techniques you can practise with a psychologist or GP to work through it. They may teach people ways of relaxing like breathing exercises or low-level mindfulness.
“If you think of it as an anxiety problem, then you deal with it like an anxiety problem,” he says.