Can you only poo at home? A gastroenterologist explains what the Germans call ‘heimscheisser’

Poo anxiety, bashful bowels, shy bowel syndrome: they’re all terms for what’s medically known as parcopresis or difficulty pooping when you’re not at home. The Germans have given a name to this condition: Heimscheißer (pronounced “heimscheisser”), which means “home shitter”.

Sufferers experience distress and anxiety at the mere thought of having to use a toilet at school, work or any public place. Some may even find it hard to poop while on holidays.

If forced to use a toilet away from home, sufferers might experience a racing heartbeat, excess sweating, nausea, tremors and difficulty passing a bowel movement.

Poo anxiety sufferers will sometimes eat less food or even avoid certain social activities that might expose them to needing to use a public toilet.

How common is it?

Poo anxiety seems to be quite common. One study of 714 Australian university students found just over 14% avoided a public toilet because of anxiety-related concerns. Another 3% avoided a public toilet because of a fear of contamination.

Poo anxiety is often triggered by an overwhelming fear of perceived scrutiny. A study involving 316 Australian university students found the most common reason leading to poo anxiety was the fear of being negatively perceived for their bowel motions. For instance, people feared others would think they took too long to pass a bowel motion or worried about the sounds and smells produced along the way.

Psychologists consider poo anxiety to be a type of social anxiety disorder. Research has found sufferers tend to have negative thoughts about themselves, such as “If I fail at my work, then I am a failure as a person”.

At the end of the day, people with poo anxiety fear being judged by others.

What are the dangers of poo anxiety?

Holding in a poo can lead to it becoming harder and drier in the colon, as more water is absorbed from it. This can lead to problems with chronic constipation.

Chronic constipation increases the risk of problems such as:

• bleeding from haemorrhoids

• pain from anal fissure (tears in the lining of the anus) and

• rectal prolapse (where a bit of the colon slips out through the anus).

This, over time, can lead to faecal incontinence.

One striking case in the United Kingdom described a teenage girl who reportedly had such a phobia of using the toilet, she would frequently withhold her poo for up to two months.

This led to a massive colon full of poo, which eventually compressed her chest cavity. That led to a heart attack and her unfortunate death at the age of 16.

Education around proper toileting

Proper education around toileting behaviour is part of the treatment for poo anxiety.

For example, the time that you spend on the toilet is important. One Turkish study found spending more than five minutes on the toilet was associated with haemorrhoids and anal fissures. People with poo anxiety are more prone to suffering from these complications of constipation, which may make the poo anxiety even worse.

Getting enough dietary fibre is important because it makes your poo softer and easier to pass. This can reduce the stress around passing a bowel motion.

In Australia, the minimum daily dietary fibre requirements for adult men is 30 grams per day and 25 grams per day for adult women.

One useful practice for healthy and regular bowel movements that I advocate for patients is the “SEN” technique:

• six-minute toilet sitting maximum

• enough fibre (eating more fruit and vegetables, and eating wholegrains)

• no straining while pooping (it should slip out fairly effortlessly).

It also helps to stay hydrated and to be conscious of medications such as opiates that can worsen constipation.

Awareness of proper toileting behaviour is important for those suffering from poo anxiety as they may become unduly fixated on their bowel motions. They may end up not adopting basic lifestyle measures that could really help make bowel motions easier all round.

Psychological treatment

Cognitive behavioural therapy is recommended as first line of treatment for poo anxiety sufferers. It can help identify and address negative thinking patterns.

Often, people take a graded exposure approach. This involves a structured step-by-step process where the sufferer confronts increasingly difficult public toilet situations to reduce anxiety and build confidence.

The most important thing to do in overcoming poo anxiety is to seek the help of a trained health professional.

Start by speaking to your doctor, who can assess whether your symptoms are likely to be from poo anxiety or potentially from another serious digestive problem. They can help prescribe medications that can help with constipation.

Your GP can also refer you to a psychologist who can arrange for cognitive behavioural therapy to help change negative thought patterns.

Routinely holding in poo is not good for you. If you’re feeling stressed about pooing at work, school or while travelling, it is worth taking the time to understand why and tackle the problem.