Anxiety around pooping, also called parcopresis, is the difficulty or inability to defecate in public restrooms or places where others may hear or smell you because of an overwhelming fear of being scrutinized or judged.
There has not been much research¹ into parcopresis to date, but extensive research has been conducted on paruresis. Paruresis is the difficulty or inability to urinate in public settings, and both conditions are classified as toilet phobias, a subtype of social phobia.² Many of the findings of paruresis can be applied to parcopresis.
Some evidence suggests³ that the psychological distress caused by parcopresis may be even more significant than that of paruresis. This is due to the more obvious sounds and smells, and the general shame and embarrassment that people suffering from parcopresis tend to associate with bowel movements.
Poop anxiety can be stressful enough to cause you to avoid social situations, travel, and public places. In very severe cases, you may even be too afraid to leave home.
One study¹ looking at the impact of paruresis on patients found that 38.1% limited or avoided travel, 33.5% avoided dating, and 15.9% reduced or avoided drinking fluids. Patients with paruresis were also reported to turn down job offers (50.8%), limit the duration of their daily work (55.6%), and hide their condition from partners (25.4%), friends (58.7%), and family (44.4%).
If you suffer from poop anxiety, you may want to know more about its symptoms, causes, and ways you can manage it. Read on to learn more about poop anxiety and how to treat it.
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Researchers are still not entirely sure what specifically causes poop anxiety. Parcopresis is yet to be formally classified, but preliminary classification¹ indicates that it is a subtype of social phobia. Social phobia shares similar symptoms with social anxiety disorder.
One study⁴ explored people's attitudes with parcopresis and paruresis and found that they were more likely to have negative thoughts and beliefs about themselves and how others perceived them. They were also shown to have a fear of being judged.
It’s possible that parcopresis can develop as a learned behavior, at least in part.⁵ So if one of your parents had a toilet phobia, you might learn to fear going to the toilet in public settings from them.
Another cause of poop anxiety⁵ might be having suffered a trauma related to passing stool in a public setting before. For example, you may have developed parcopresis if you were teased as a child about pooping or had a traumatic experience around pooping in a public restroom.
It is thought that parcopresis is an underdiagnosed condition because people feel too embarrassed to speak to their doctor about it. You may be hesitant to raise your concerns about poop anxiety with your healthcare provider because of a perceived stigma around the symptoms.
One tool used to diagnose parcopresis is the Shy Bladder and Bowel Scale³ (SBBS). If you think you may be suffering from poop anxiety, read the following statements and see if they apply to you:
I can’t have a bowel motion when around others in a bathroom or restroom.
I avoid going to the toilet even if I need to have a bowel motion.
I delay going to the toilet even if I need to have a bowel motion.
I worry that I cannot empty my bowel when close to others.
My bowel habits make my life unbearable.
My bowel habits are the most significant contributor to my anxiety in life.
My bowel habits reduce my quality of life.
My bowel habits make me feel frustrated.
If you agree with any of these statements and have felt this way for longer than six months, you may be suffering from poop anxiety.
The symptoms⁴ of poop anxiety can have a significant impact on your life. You may experience some of the following symptoms if you struggle with parcopresis:
Avoiding situations² such as trips, sporting events, and parties where you might need to have a bowel movement in a public setting
Inability to have a bowel movement in public restrooms
It’s important not to confuse the symptoms of poop anxiety with organic pathology. Your doctor may need to make sure that you don’t have an underlying medical condition, such as chronic constipation, that could be causing your symptoms.
Some medical conditions³ that cause erratic and unpredictable bowel movements, such as irritable bowel disease (IBD), can worsen poop anxiety.
The first step in managing poop anxiety is acknowledging it. You may feel ashamed and embarrassed to speak to your doctor about your symptoms. Recognizing that you may have poop anxiety and raising it with your doctor is the first step to getting treatment. It is also important that your doctor treats the issue sensitively and understands your concerns.
Once any underlying physical cause for your symptoms has been excluded, and your doctor is confident that you have parcopresis, you can discuss treatment options.
There are two main methods for treating poop anxiety:
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy
CBT has been shown⁶ to effectively manage anxiety and improve the quality of life in people who suffer from a wide range of anxiety disorders. CBT helps you identify and assess your thoughts and behaviors to alter your perceptions, emotions, and behavior patterns.
Although clinical trials¹ testing the efficacy of CBT for treating parcopresis are lacking, it’s likely to be successful based on its efficacy in treating other anxiety-based disorders, such as social anxiety disorder and specific phobias. Case reports⁴ on the use of CBT in parcopresis have shown its efficacy as a treatment option.
The two most commonly used CBT treatment methods are:
Exposure therapy — exposing yourself to situations in which you experience poop anxiety with the guidance of your healthcare professional
Cognition therapy — identifying and changing negative thinking patterns
Both forms of CBT may be beneficial in the treatment of parcopresis.
There is currently little evidence supporting the use of medication specifically for parcopresis. However, selective serotonin reuptake inhibitors (SSRIs) are a first-line therapy for most anxiety disorders, including social anxiety.
A case report⁴ of a 23-year-old man with social anxiety and parcopresis found that SSRI therapy led to a small improvement in his condition. After six months of SSRI therapy, CBT was added to his pharmacotherapy, and he improved further. This case study suggests that a combination of CBT and pharmacotherapy with an SSRI may be the best option for treatment.
Management of poop anxiety will consist of one or a combination of both. Using a combination of both treatment modalities may be more effective than using either one form of treatment or the other.
Poop anxiety, or parcopresis, is the difficulty or inability to have a bowel movement in a public setting. The condition is likely underdiagnosed because of the embarrassment and stigma people suffering from parcopresis feel, but it may be more common than we realize. Poop anxiety can significantly interfere with your daily life. The fear of having to pass stool in a public setting can lead to avoidance behaviors and eventually to social isolation.
If you have poop anxiety, the first step is to speak to your doctor about your symptoms. Once your doctor has confirmed the diagnosis and excluded any physical pathology, you can work out a treatment plan together.
Toilet phobia | Anxiety Disorders Association of Victoria, Inc.