Have you ever wondered how your body knows when is it time to pass stool and when is it the time to pass only gas? Have you ever wondered how both existing in the same route usually do not create confusion? It is like as humans, we know when we need to use the loo or when we must excuse ourselves only for a few seconds. So, how does it happen? Your digestive system is an intricate network of organs, nerves, and muscles which work in harmony. Among its many functions, one of them is to be able to differentiate gas and stool, and it is an essential one as it prevents embarrassing accidents.

How Does Your Body Know?

Your gastrointestinal (GI) tract is the long tube that runs from your mouth to your anus. Once food moves through your stomach and intestines, the digestion process is complete, and waste material gathers in the rectum—the final storage area before elimination.

Directly below the rectum is the anal canal, which serves as the passage between the rectum and the anus. This final section of your GI tract plays a crucial role in distinguishing between gas and stool.

Your Body Has Gatekeeper

These gatekeepers are called the sphincters. Let's have a look how it works:

• The internal anal sphincter – This involuntary muscle remains tightly closed at rest, maintaining continence.
• The external anal sphincter – This voluntary muscle gives you control over when to pass stool or gas.

As per gastroenterologists, the external sphincter is our squeeze muscle and when we feel the urge to poop but are not present in the right place, we engage this muscle to hold it in. Whereas the internal sphincter automatically tightens to prevent any accidental leakage.

Anal Sampling Mechanism

One of the key reasons you can distinguish gas from stool is the rectoanal inhibitory reflex (RAIR)—also known as the anal sampling mechanism.

Here’s how it works:

When the rectum fills with gas or stool, the internal sphincter temporarily relaxes, allowing a small amount of contents to enter the anal canal.

Sensory receptors in the anal mucosa (a specialized membrane lining the anal canal) then "sample" the contents to determine whether it’s gas, liquid, or solid.

If it’s gas, your body knows it’s safe to release. If it’s solid, the external sphincter stays engaged until you decide it’s time to poop.

What is extremely essential in such a scenario is our body's ability to differentiate between gas and stool. Scientists believe that it involves a high concentration of sensory nerve endings in the anal canal that helps us understand the difference. These work due to some of the specialized nerve receptors, which include:

• Meissner’s corpuscles – Sensitive to touch and vibration
• Pacinian corpuscles – Detect pressure changes
• Krause end-bulbs – Respond to temperature shifts
• Genital corpuscles – Sensitive to friction and texture

In fact, a study titled Anorectal Sampling: A Comparison of Normal and Incontinent Patients examined how the anal sampling mechanism contributes to continence. The researchers compared 18 individuals with fecal incontinence to 18 healthy controls. It found that spontaneous sampling, which is referred to as the ability to detect rectal contents occurred in 16 out of 18 healthy individuals but only 6 out of 8 incontinent patients. This study supported the idea that the anal sampling mechanism plays a crucial role in maintaining continence. When it malfunctions, people struggle to differentiate between gas and stool, leading to accidental leakage.

For many women with endometriosis, chronic and painful gastrointestinal symptoms are part of daily life, yet they often go untreated due to under-recognition by healthcare providers and a lack of evidence-based treatment options.

Endometriosis is a chronic, inflammatory gynaecological disorder affecting one in seven Australian women. It causes a range of unpredictable and often severe symptoms, including dysmenorrhoea (painful periods), pelvic pain (below the belly button and between the hips), and dyspareunia (pain during sexual intercourse). These symptoms disrupt daily life, impacting finances, relationships, mental health, and the ability to work, learn, socialise, exercise, and have children.

According to Jane Varney, Senior Research Dietitian at the Department of Gastroenterology, Monash University, gastrointestinal symptoms such as abdominal pain, bloating, distension, diarrhoea, constipation, and painful defecation affect more than three-quarters of sufferers. These symptoms often intensify during menstruation, occur regardless of bowel involvement, and overlap with irritable bowel syndrome (IBS), which affects between 10.6 per cent and 52 per cent of women with endometriosis.

Why current treatments fall short

Despite the high prevalence and burden of gut symptoms in endometriosis, treatment options are limited. Few treatments specifically target these gastrointestinal issues, and some, such as progesterone and opioid medications, can make them worse. Surgery can come with long waiting times, high costs, ongoing pain, and the need for repeat procedures, while hormone treatments and pain relief medicines are limited by modest effectiveness and troublesome side effects.

It is no surprise that many women turn to self-management strategies such as diet and nutritional supplements to help control symptoms and take an active role in their care. International data shows that more than 58 per cent of women with endometriosis have tried supplements, though only 43 per cent reported an improvement in pain. In Australia, three-quarters use fish oil, multivitamins, vitamin B, or vitamin D.

Dietary changes are also common. Surveys from Australia, Holland, the UK, and beyond reveal that between 27 per cent and 84 per cent of women with endometriosis use dietary modifications to manage symptoms, with many reporting benefits. Popular approaches include anti-inflammatory diets or avoiding red meat, gluten, dairy, lactose, FODMAPs, caffeine, soy, and alcohol. However, the evidence for most of these is limited or absent.

The EndoFOD study

The study was the first randomised controlled crossover feeding trial in this patient group. Thirty-five participants were assigned to a 28-day low FODMAP diet or a control diet based on Australian dietary guidelines, with both diets nutritionally matched except for their FODMAP content. After a washout period of at least 28 days, they switched to the other diet. Each diet began on the first day of a menstrual cycle to account for hormonal symptom fluctuations.

By the end of the trial, 60 per cent of participants responded to the low FODMAP diet, with significant improvements in gut symptom severity. Abdominal pain, bloating, stool consistency, and quality of life all improved. Changes were noticeable by week two, continuing steadily until the end of the intervention.

What it means for endometriosis care

What’s next for diet research

Doctors are calling for a national strategy and a public awareness campaign to improve end-of-life care, warning that dying is often treated as an “unexpected” event or last-minute crisis, even when a patient’s condition has long been deteriorating.

The Royal College of Physicians (RCP) said healthcare systems tend to prioritize curative treatments, despite many patients living with progressive, life-limiting conditions such as frailty or advanced chronic illness. The college urged a “cultural shift” in both healthcare and wider society to recognize the value of palliative and end-of-life care.

Dr Hilary Williams, RCP’s clinical vice president, as reported by The Independent, described recognizing the end of life as “an act of clinical courage and kindness.” She stressed that early planning could improve comfort, dignity and choice for patients.

Most Deaths Are Predictable, Yet Families Unprepared

Citing earlier research, the RCP said around 70% of people die from long-term health conditions that typically follow a predictable course, meaning death can be anticipated well in advance. Despite this, many patients and families are left unprepared, missing opportunities for open discussions that could shift the focus from aggressive treatment to quality-of-life support.

The RCP has recommended that the Government:

• Launch a public campaign on end-of-life and palliative care
• Support professional education to improve recognition and delivery of such care
• Develop a national strategy, including workforce training

The college also warned of barriers such as social care challenges, funding gaps and workforce shortages that limit timely, compassionate care.

Need for Honest Conversations

Dr Williams said too often recognition that someone is approaching the end of life happens only in the final days or weeks, usually in acute care settings. She called for valuing continuity of care, experienced decision-making and time for clinicians to hold honest conversations with patients and families.

“With treatment options expanding, knowing when to start or stop interventions and when to focus on quality of life has become more complex,” she said. “These are skills rooted in expertise, and the system must value them.”

Support from Other Medical Leaders

Dr Nick Murch, president of the Society for Acute Medicine, as reported in The Independent said better planning could allow more people to die with comfort, dignity and in a place of their choosing.

Dr Suzanne Kite, president of the Association for Palliative Medicine, emphasized the need for a national strategy to guarantee access to high-quality palliative care at any time and location, supported by training and public dialogue, as reported by The Independent.

Charity Sue Ryder, which provides hospice and palliative services, backed the RCP’s call, noting that some patients die before hospice admission due to late referrals. The charity urged healthcare professionals to consider palliative care from the point of a terminal diagnosis.

Government Response

A Department of Health and Social Care spokesperson said the Government aims to ensure compassionate, high-quality care from diagnosis to end of life. Under its 10 Year Health Plan, more healthcare will move from hospitals into communities, with palliative care playing a central role. The department has invested £100 million in hospices, the largest such funding in a generation.

Separate from Assisted Dying Debate

The RCP clarified that its position on end-of-life care is separate from its stance on the assisted dying Bill. While acknowledging deficiencies in the proposed legislation, the college urged further safeguards to protect vulnerable patients and maintain trust in the doctor-patient relationship.

A viral social media video warning against “power peeing”, pushing while urinating, has opened up a surprising discussion: many of us may be using the bathroom in ways that can harm our bodies. Pelvic health experts say there is, in fact, a right and wrong way to pee, and the wrong habits could cause lasting problems.

Why Bathroom Habits Matter

While urination seems automatic, the way you do it can have long-term effects on the bladder and pelvic floor muscles. The pelvic floor acts like a hammock, supporting organs such as the bladder, uterus, and bowels.

For urination to happen, these muscles need to relax so the bladder can squeeze urine out. If the process is disrupted, by straining, holding too long, or going too often, it can weaken muscles, interfere with bladder signals, and contribute to pelvic floor dysfunction.

This dysfunction can lead to urinary leakage, incomplete emptying, urinary tract infections, sexual difficulties, and pelvic organ prolapse, where pelvic organs shift out of their normal position.

Habits That Can Harm Pelvic Health

Experts point to several common but harmful urination habits:

Pushing to Pee: Trying to speed things up by straining actually tightens the pelvic floor instead of relaxing it. Over time, this can result in incomplete emptying, post-void dribbling, and difficulty coordinating the bladder and pelvic muscles.

Hovering Over the Toilet: Often done in public restrooms to avoid contact with surfaces, hovering engages hip and leg muscles, making pelvic relaxation difficult. This can leave urine behind in the bladder and raise the risk of infections.

Peeing “Just in Case”: Going to the bathroom before the bladder is full trains it to signal the need to urinate with smaller volumes, leading to overactive bladder and frequent urges.

Holding It Too Long: Ignoring the urge can overstretch the bladder, reduce elasticity, and make the brain less responsive to bladder signals. This increases the risk of bacterial buildup and infections.

Peeing in the Shower: Standing can make it harder for some people, particularly those with pelvic floor dysfunction or certain prostate issues, to fully empty the bladder. It can also condition the body to associate running water with the urge to urinate.

Why You’ll Never Be Completely “Empty”

The bladder is continuously filling with urine, so it will never be completely empty. Forcing out the last drops by pushing is unnecessary and can cause more harm than good.

How to Pee the Right Way

Experts say healthy urination habits can be learned and practiced:

Belly Breathing: Sit on the toilet, lean forward slightly, and breathe deeply from the belly. This encourages the pelvic floor to relax so urine flows naturally.

Reverse Kegels: Instead of squeezing and lifting, focus on releasing and opening the pelvic muscles as you exhale.

Double Voiding: After finishing, stand up briefly and then sit down again to allow the bladder to finish emptying.

Shift Your Position: Gently moving the hips can help the bladder release more urine without straining.

Track Your Patterns: Keep a three-day “pee diary” to monitor timing, fluid intake, and urges. Ideally, aim to urinate every two to four hours in the day and no more than twice at night.

When to Seek Help

If issues such as leakage, frequent urges, or difficulty emptying persist, consulting a pelvic floor therapist or urologist is recommended. With proper guidance, it is possible to retrain the bladder and muscles for healthier urination.

Ultimately, the simplest advice is to sit, relax, and let the body do its job naturally, no pushing, no rushing, and no multitasking on the phone. Your bladder, it turns out, prefers a calm, unhurried routine.