Nervous about using the bathroom at work? A gastroenterologist shares advice

Trisha Pasricha, MD

I’m a second-generation gastroenterologist. In my world, no bathroom topic is off-limits. Growing up, my father, a gastroenterologist at the Mayo Clinic, spoke so excitedly to me about the awe-inspiring ways our guts work. I always knew there was no more thrilling a career out there for me (yes, the two of us are a delightful pair at dinner parties).

I realize it can be hard to talk about subjects that many people consider uncomfortable, whether it’s bowel leakage, hemorrhoids or the correct way to wipe. But the first step to normalizing our bodies and gut is talking openly about the things we all do every day (well, actually, it’s okay if you don’t poop every day.)

So let’s find out some of the burning bathroom questions that readers have messaged me.

1. I get shy pooping at work. How do I mitigate that?

Our colons are most active in the first two hours after waking - and are further emboldened by coffee, food and exercise. So if you have coffee with breakfast in the morning, and exercise before work or perhaps sprint around to catch the train, you’re physiologically priming yourself to poop on company time.

You could deliberately plan a cushion in your schedule to use the bathroom before you head out the door. But if that isn’t possible, here’s my advice:

• If you have to go, just go. We talk so much about the importance of self-care, but let me tell you, this is the real test. Do it for your future self. One of the colon’s major jobs is to absorb water. So every second that waste sits around with nowhere to go, the colon sucks water out of it back into the bloodstream. This means that later on, that same poop will be harder, drier and more pebbly. It will not be as easy to pass. Worse, if a harder poop causes you to strain on the toilet, you put yourself at risk of hemorrhoids.
• Relaxation is a critical component of pooping - the anal sphincters need to feel safe. Try doing a few vagal maneuvers, such as box breathing or a Valsalva maneuver. Still, it’s not easy when you can overhear Jess from accounting washing her hands for the full excruciating CDC-recommended 20-second count just a few feet away from you while you’re trying to wrap up business.
• Find the “safe” bathroom at work. Do your due diligence - the quietest bathroom may not be the most convenient. It may be the dark, weird one in the basement or the single-stall havens in the lobby. And once you figure out which one offers the most privacy, tell no one your secret.
• Create some white noise. Shuffle some toilet paper out of the holder. Cough. “Accidentally” switch on the sound of a TikTok video on your phone. Time it at the critical moment, and who could really swear later in court what it was they heard in the stall next door?

2. Why does coffee make me go to the bathroom?

Your gastrointestinal tract reacts differently depending on what you eat. For instance, a fiber-rich meal slows down the stomach, whereas a high-fat meal revs up how quickly the gut pushes its contents forward. Some studies have found that for about a third of people, coffee is a powerful stimulant of colon contractions. Both regular and decaffeinated coffee can amplify the colon’s activity within four minutes of drinking it - and that boost is sustained for about 30 minutes afterward.

Liquids can take around 20 minutes to pass through the stomach, but coffee can have an effect within minutes. So what gives?

Scientists have hypothesized that caffeine is a strong stimulant of something called the gastro-colic reflex. When we eat, that stretching of the stomach signals to the body that we need to make more room for the incoming meal. Through that reflex, waves of contractions in the colon begin to push anything still hanging around forward - and outward.

3. How do bidets work? I’m honestly afraid to Google the real mechanics of it.

I often recommend bidets because they’re gentle and hygienic. But many of you have sent me questions about them. I’ll start with one of the biggest concerns: How do we avoid poopy water spraying us?

Let me just say, if this were remotely a regular possibility, no one would use bidets. Like, ever. Bidets would not have the cult following they so rightly have earned.

Whether you’re using an attachable bidet nozzle or an entire bidet seat on your toilet (these are both different from the stand-alone bidet bowls you often see in Europe), the water is absolutely not coming from the bottom of the bowl.

When you connect a bidet to your indoor plumbing, the piping routes some water into the toilet bowl, per usual, and routes an entirely separate stream through the bidet nozzle. The two streams do not mix.

Here’s what happens next: You poop into the toilet bowl as you would, and the bidet nozzle sprays you clean. Most bidets have adjustable spray angles and pressures, so you direct the water and can easily avoid any splashing. Many models have nozzles that tuck themselves away when not in use, meaning, even if you splattered while pooping, they’re shielded. Several also have a “self-cleaning” feature, just for the nozzle.

Lastly, depending on the bidet, you may still want or need to pat dry afterward. Many fancy bidet seats, in addition to being heated, have a built-in air dryer of their own - ah, the joy.

4. How do you know if it’s hemorrhoids or something more serious?

If you have external hemorrhoids, or prolapsed internal hemorrhoids (meaning hemorrhoids originating from inside the anal canal that pop out from time to time), you can often feel those easily. It might be like a small lump that could be tender. Internal hemorrhoids are harder to appreciate.

Talk to your doctor and have them confirm. If you’ve experienced rectal bleeding, hemorrhoids are a very common cause - but it’s important we don’t miss anything more serious.

5. Is diarrhea ever normal?

Sure. It all depends on how we’re defining diarrhea. Looser, more frequent stools because you’ve adopted a plant-based diet and are building a healthy gut microbiome? Normal. Watery diarrhea and stomach cramps every time you eat gluten? Not normal. When in doubt, ask your doc.

Trisha Pasricha is an instructor in medicine at Harvard Medical School and author of the forthcoming “You’ve Been Pooping All Wrong.”