Parcopresis - a case study

Parcopresis – a case study

Marcus* was quite evasive on the phone when he rang me, but also wanted to know whether I’d ever treated his condition before, and so told me he had parcopresis. He was surprised when I knew that parcopresis is the medical term for ‘shy bowel’ and he arranged to come and see me.

“It started as a work thing that I did. I was really self-conscious because of other guys standing outside the stall waiting to use the toilet. I couldn’t use the public ones as we’re not allowed, and anyway they open straight onto the corridors, so that’s just as bad.

“It might seem trivial to some people. After all there are much worse things to have wrong aren’t there? But it’s really beginning to affect me – not just mentally but physically.”

When your stool reaches your rectum, it sends a signal letting you know that it’s time to go. By continually ignoring this Marcus had had effectively trained himself to be less sensitive to the signal. The stomach cramps that he’d first noticed when he started with a shy bowel had now gone. What he had now though was constipation, as his stools dried and became more solid.

Like so many people Marcus had started a habit because he thought it would help him. But as is all too common that habit was now causing him even greater problems. I asked Marcus what advice or treatment he’d sought for the constipation and his answer was “none”.

“I haven’t been to the doctor about it because I’m embarrassed, and because I think they’ll see it as trivial. I did try to talk to the pharmacist at the chemist, but he wanted me to see the doctor and I was back at square one. So, I’ve been using Ducolax tablets, and I’ve been using coffee to kickstart it too.”

Marcus was initially disappointed when I told him that I wanted him to see the doctor too. He wasn’t supposed to take the laxatives for more than five days, and it had been nearly five months. I couldn’t treat him knowing that he was potentially harming himself. But there was another reason too.

When he came back after seeing the doctor the other reason became apparent to Marcus. He’d come to me asking for help about his parcoparesis, or shy bowel. Having seen the doctor he now understood that in fact he needed to recover his sensitivity to the ‘time to go’ signal. I promised that should he still need it at the end we’d tackle his shy bowel.

I worked with Marcus on regaining that sensitivity, and encouraged him to listen to his gut and what it was telling him about his eating and toilet habits. We also worked on reducing his apprehension about defecating, as he had come to expect it to be difficult and painful.

One practical tip that everyone can benefit from is to have your feet resting on a raised surface so that you sit in a squatting position. That immediately makes things easier, and cuts out a lot of straining or struggling.

After a couple of months, and his constipation had pretty much gone, I asked Marcus if he still wanted to work on his shy bowel. “No thanks,” he told me “but since I’ve been listening to what my body’s telling me I’ve not been worrying about what other people might be thinking” – which was the result he’d hoped for all along.

* Marcus’ real identity has been protected, and he is happy to share his story.

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