Straining on the toilet is hazardous to your health?

Factual Questions
1

So I was watching this X-Files episode, War of the Corphorages (sp). In it, there’s a death on a toilet that Scully theorizes was caused, IIRC, by the man overstraining on the toilet. Having gone through a bit of constipation lately, that got me thinking. I know that straining can lead to a very common malady: hemmeroids. I also know there are stories of people who’ve had strokes, seizures, detached retinas, death, or whatever because of straining.

What I’d like to know is, what is the truth behind those stories? What is the likelihood of such a thing happening to a person who DOESN’T already have a propensity for strokes, seizures, detached retinas, and death that could come about by anything as simple as heavy lifting? Are all constipated people doomed (DOOOOOMED!)?

2

If the urban legends have any truth to them, don’t do it on a plane.

(Straining on a plane!!! :eek: )

3

I thought the problem in that story was flushing while you were still sitting?

4

When you strain hard, you’re actually doing what is called the Valsalva maneuver. You do this when you exhale with your mouth and nose (or your glottis) closed. People do it a lot to “pop” their ears when they fly.

This increases the pressure in your chest cavity. Increased thoracic pressure decreases venous return into the heart. This is because your venous system is a low pressure system. Do it long enough, and your cardiac output will drop. Incidentally, high thoracic pressure can also be caused by someone performing rescue breathing too often during CPR, and can reduce the effectiveness of CPR.

According to wikipedia (yes, I know, not the best cite):

and

5

So the answer to my questions are…? :smiley:

6

Yo! Elvis!

7

Believe it or not, there is also another real reason why straining at stool is dangerous… for people with heart problems.

When I was a junior resident in surgery, we were taught to perform rectal exams on every patient that came to be surgerized. We did not like this duty, neither did they, so our seniors and superiors impressed on us long and soundly that it was imperative and not optional. The only break we got came when it was a heart patient. If a man was three months or less out from a heart attack, we were excused from the digital rectal exam. Why? Because it was known to bring on arrhythmias. You could start a new heart attack – or worse, a “code” – by doing a digital rectal.

This is because of a vasovagal response, meaning a response by the blood vessels to an impulse directed from the vagus nerve. The vagus, the name of which means “wanderer”, is a cranial nerve that starts in the brain, exits the skull, wraps around the esophagus, sends sprigs off to innervate the heart, heads down over the stomach, and terminates with at least one branch in the anal sphincter. If you get your finger in there and squidge around, or if hard stool passes the sphincter with enough force, sometimes you trigger a reaction in the nerve. It’s known empirically that this sometimes stops hearts. I don’t know the exact how or why, but I don’t have to know. Empirical is good enough for me.

And, as support for empirical evidence, as a medical examiner I not infrequently see dead people with the famous Ring of Elvis – Johnny L.A. is quite right about that – that is, the mark of the toilet seat impressed upon their buttocks into the livor mortis. Death while peeing is comparatively quite uncommon.

If you are young and healthy and have no heart problems, straining at stool will give you nothing worse than hemorrhoids. If you have a heart problem you don’t know about, straining at stool could give you a chance to find out. Remember, for between a fifth and a quarter of all people with coronary artery disease, the first symptom is sudden death.

You’re not middle-aged are you?

8

Hey…it killed Big Pussy. That’s all I needed to know about the subject.

9

I remember hearing of an “unsolved murder”, where an elderly gent was found dead ,with his trousers round his ankles, and there were signs of a struggle… but no forensic evidence of a second party. Dunno how long it took, but they eventually discovered the poor aul’ soul had given himself a brain hemorrhage straining to move his bowel and presumably had thrashed about in his death throes…

10

(not quite a hijack, but…)
why stick your finger up the rectum for every surgery? What does that tell you about the health of a person who needs surgery for, say, repairing a broken elbow?

11

On land, that’s true, but not offshore. The Coast Guard reminds us that most of the drowned male boaters, whose corpses are found, have one thing in common. Their flies were open. The lesson is, “Don’t pee off the side of the boat.”

12

Heh. “The ring of Elvis”. Doctor humor is the best! :smiley:

13

I, on the other hand, have been straining to make a pun out of the Latin [“annulus Elvis”, if my schoolboy Latin serves, assuming "Elvis is a third declension i-stem noun), but I am failing miserably, despite the puerile anus/annulus jokes that abounded in Ancient Rome. Points for whoever can succeed where I failed.

14

Especially into the wind!

gabriela, “surgerized”??? :eek:

15

Oddly enough, considering the OP, this point also came up in an X-Files episode, “Quagmire”.

16

I was curious about this topic once - LINK

17

Elvis was by no means the first King to die on the toilet.

George II experienced an aortic dissection while attempting bowel evacuation in October 1760, giving him the dubious honour of being the first monarch to die on the throne.

18

It tells you whether he has colonic bleeding of which he is unaware. (Because you took your finger out and wiped the glove tip on a guaiac card, which at that distant era you developed yourself by squirting with a chem solution that turned blue in the presence of hidden blood; nowadays you would not be permitted to do such an important test yourself, and you would fold a cardboard lid over the fecal smears, tape it shut, and mail it off to the lab to squirt it for you.)

Which is important to the general health of the patient, and is therefore related to how well he or she will withstand surgery, make it through anesthesia, handle aftercare, and survive to exit the hospital. When patients do not exit the hospital alive, medicine doctors sigh. Surgical doctors report the matter to eachother in a vast amphitheatre filled with a highly critical audience of older surgeons; the ordeal is called an M&M, perhaps because you melt because of your mouth, not because of your hands. It was not fun for the chief resident to get up before that audience and present the postsurgical death of any patient, and you bet he or she would not have enjoyed doing so if the answer to “Did you or one of your minions check the guaiac before surgery?” was “Er, no…”

As I was training in the general surgery department of a vast and huge St. Elsewhere’s (a charity hospital in New York City), we didn’t do broken elbows. Orthopedic Surgery did broken elbows (and, I presume, checked their unfortunate owners’ rectums for hidden bleeding). We did people’s gall bladders, hernias, heart surgeries, trauma. They were poor people in bad shape, and a lot of them had hidden rectal bleeding that they didn’t know about. Also coronary problems that they didn’t know about.

But they didn’t have a choice about the rectal.

I doubt very much your average walk-in surgery today insists on the ritual. It was another era.

19

KlondikeGeoff, are you surprised at any medical jargon?

There are three kinds of jargon in the medical field, all serving as barries to protect the initiates from the outsiders. The first is our complex language based on its screwy mixture of Latin and Greek roots. The second is the series of familiar abbreviations all complex technical languages develop. And the third is the slang, including the funny abbreviations you don’t let outsiders know.

In the first group, exempla gratia, “subarachnoid hemorrhage”. In the second group, “SAH” for the same thing. In the third group, “popped a berry” for how the problem came to occur. Followed by “ctd”, which is the dark humor abbreviation among insiders for “dying because of it”. It means “circling the drain”.

Tell me one from your field. Every field has some.

20

Speaking of death at stool, a neighbor of ours, a morbidly obese man in his 40s, died at stool at home in the upstairs bathroom. He was too big for them to get his body down the steps, though they worked on it for hours. So finally they removed the bathroom window and greatly enlarged the hole in the wall where it had been, and took him out with a crane, in front of what by that time was a huge audience. Though this guy was unpleasant to be around, and was disliked by nearly the entire neighborhood, his impromptu wake was very well attended.