Shy Bowel Syndrome: Psychological Impact and Coping Strategies in Vietnamese Society

In Vietnam, 'shy bowel' syndrome, medically known as 'parcopresis,' is increasingly being recognized not just as a habit but as a condition requiring psychological treatment. Individuals suffering from this syndrome often face difficulties using restrooms in public places such as schools, offices, or shopping malls. When forced to use them, they may experience symptoms like rapid heartbeat, cold sweats, and nausea. A study of 700 university students in Australia revealed that over 14% avoided public restrooms due to anxiety, and 3% feared hygiene issues. The underlying causes include psychological concerns about being judged for noises, odors, or prolonged use of the facilities. Experts classify parcopresis as a type of social anxiety disorder. Sufferers are sensitive to perceived judgment from others, leading to a vicious cycle where increased anxiety makes defecation even more challenging. Associate Professor Vincent Ho, a gastroenterologist at Western Sydney University, explains the physiological aspect through the 'brain-gut axis' mechanism. Defecation is controlled by two sets of anal sphincter muscles: the inner one operates automatically, signaling the brain, while the outer one is under voluntary control. The brain assesses the surrounding environment; if it deems the space safe and private (like at home), it commands the outer sphincter to relax. Conversely, if the brain perceives the environment as unsafe, the outer sphincter remains tightly closed. To cope, many individuals resort to skipping meals, reducing water intake, or declining long trips. However, digestive experts warn that forcibly holding in bowel movements can lead to chronic constipation, increasing the risk of hemorrhoids and rectal prolapse. Associate Professor Vincent Ho proposes the 'SEN' principle to improve gut health: S (Six-minute toilet sitting): Avoid sitting on the toilet for more than 5-6 minutes to prevent increased pressure on veins, which can cause hemorrhoids. E (Enough fibre): Increase fiber intake from vegetables, fruits, and grains to soften stool. N (No straining): Do not strain, allowing the defecation process to occur naturally. Furthermore, adequate hydration, regular exercise, and establishing a fixed time for toilet use can help improve bowel reflexes. 'Understanding the interaction between the brain and the digestive system is the first step to changing this habit,' stated Dr. Ho.