Returning to shared spaces—like schools or offices—also means returning to public restrooms. For some individuals, this transition comes with more than just minor discomfort. The anxiety around using public toilets, especially for defecation or urination, can be so intense that it interferes with daily functioning. This condition is medically recognized as parcopresis (shy bowel syndrome) and, in some cases, paruresis (shy bladder syndrome).

What Is Shy Bowel and Shy Bladder Syndrome?

Parcopresis refers to the difficulty or inability to defecate in the presence of others, especially in public restrooms. Similarly, paruresis describes the difficulty in urinating under similar circumstances. These conditions are not simply a preference for privacy—they are marked by psychological and physiological barriers that inhibit normal bodily functions.

Individuals with parcopresis often find themselves unable to initiate or complete a bowel movement unless they are in a perceived safe, private, and predictable environment, typically at home. The same applies to paruresis, where individuals may only be able to urinate in the comfort of familiar surroundings.

In public or semi-public restrooms, anxiety can trigger the sympathetic nervous system—the body’s fight-or-flight response—which disrupts the relaxation of pelvic muscles required for urination or defecation. As a result, individuals may freeze mid-process, feel pressured to rush, or avoid the restroom altogether, leading to discomfort or medical complications such as constipation or urinary retention.

The Psychological Link

Both shy bladder and shy bowel syndromes are linked to social anxiety disorder. The fear is not necessarily of the act itself but of being heard, judged, or perceived negatively by others. This can create a feedback loop: the more one worries about not being able to go, the harder it becomes.

Over time, this anxiety can escalate to significant social avoidance. People may plan their day around access to private restrooms, avoid travel, limit hydration or food intake, and even decline job opportunities or social engagements. In severe cases, this avoidance behavior can lead to agoraphobia—a fear of being in places where escape might be difficult.

Possible Contributing Factors

While psychological in nature, these syndromes may be more pronounced in individuals with pre-existing physical conditions. For instance, inflammatory bowel disease, irritable bowel syndrome, urinary tract infections, or prostate conditions can exacerbate restroom-related anxiety due to urgency or frequency, increasing the likelihood of distress in public settings.

Management and Treatment

Despite the challenges, both conditions are treatable. The first step is a medical evaluation to rule out or address any underlying physical health issues. Once physical causes are excluded or managed, psychological approaches become central to treatment.

Cognitive-behavioral therapy (CBT) is considered the gold standard. It helps individuals identify and challenge negative thought patterns and gradually exposes them to anxiety-inducing situations—a process known as exposure therapy. In this case, it may involve slowly increasing comfort with public restroom use.

Relaxation techniques, including deep breathing and mindfulness, can help regulate physiological responses to anxiety. In some cases, short-term use of anti-anxiety medications may be recommended to support behavioral therapy.

With the right interventions and support, individuals affected by shy bladder or bowel syndromes can regain confidence and return to normal daily functioning—including using public restrooms without distress.

'Diagnostic Anomaly' is a Health And Me Series, where we dive deep into some of the rarest of rare diseases. Here, we trace such diseases and what causes them. We also try to bring case studies around the same.

Before biologist Silvana Santos set foot in Serrinha dos Pintos, a remote Brazilian town tucked into the mountains of Rio Grande do Norte, families had long lived with unanswered questions. As BBC reports, the children there were losing the ability to walk, often before reaching adulthood. No one knew why—until Santos arrived more than two decades ago and uncovered a genetic mystery that would put the town on the global medical map.

A Name for the Nameless

With fewer than 5,000 residents, Serrinha dos Pintos had long operated as a close-knit, self-contained community. But beneath the surface of everyday life was a recurring pattern: a growing number of children unable to walk, gradually losing strength in their limbs.

When Santos, a geneticist from São Paulo, arrived for what was meant to be a short holiday, she didn’t just see a town—she saw a puzzle.

That puzzle led her to discover and name Spoan syndrome, as BBC reports, a previously unidentified genetic disorder that weakens the nervous system and affects motor control. It only develops when both parents carry the mutated gene, a scenario made more likely in Serrinha due to a high rate of intermarriage within extended families.

The Town Where Family Ties Run Deep

In Serrinha, it’s common for cousins to marry—a reflection of the town’s geographic isolation and cultural traditions. Santos’s early studies found that more than 30% of couples in the town were related, and a significant number of these unions had produced at least one child with a disability.

Worldwide, cousin marriages are not uncommon, but they come with higher genetic risks. In Brazil, such marriages account for only 1–4% of unions, compared to over 50% in countries like Pakistan. While most children born to cousin couples are healthy, the chance of recessive genetic disorders, like Spoan, doubles to about 5–6% per pregnancy.

From Diagnosis to Global Discovery

Santos’s investigation didn’t end with just a diagnosis. What began as a three-month field visit evolved into years of research.

She drove thousands of kilometres, collected DNA samples door-to-door, and documented family trees over coffee and conversation. Her work culminated in a groundbreaking 2005 study that identified Spoan syndrome and traced its genetic roots.

The syndrome, she found, was caused by the loss of a tiny fragment of a chromosome, triggering a malfunction in brain cells. While local legends pinned the condition on a randy ancestor named Maximiano, genetic evidence suggests the mutation arrived over 500 years ago with European settlers—most likely Sephardic Jews or Moors fleeing the Inquisition.

To date, 83 cases have been confirmed globally—including two in Egypt—strengthening the theory of a shared Iberian ancestry.

Changing the Conversation Around Disability

Santos’s discovery didn’t just change medical records; it reshaped local attitudes.

Once dismissed with slurs like “crippled,” residents with Spoan are now recognised by name, their condition understood with empathy and scientific clarity. Many have received motorised wheelchairs and occupational therapy, improving not just mobility but also dignity.

For Inés, whose two sons are among the oldest living Spoan patients in the town, the transformation is bittersweet. “We love our children the same,” she says, “but we suffer for them.” By age 50, most Spoan patients require full-time care.

A Way To Go Ahead

While a cure for Spoan remains distant, education and awareness are proving powerful tools. Santos is now part of a major government-backed initiative to genetically screen 5,000 couples for risk of recessive diseases. The goal isn’t to discourage cousin marriages, but to provide informed choices for families like Larissa and Saulo—who only discovered they were distantly related after months of dating.

Santos, now a university professor, continues to lead a genetics education centre and remains deeply involved in outreach in Brazil’s northeast. She may no longer live in Serrinha, but to locals, she’s more than a scientist.

“She’s family,” says Inés.

In a controversial move with far-reaching health consequences, the U.S. House passed the Trump administration’s sweeping domestic agenda legislation—dubbed the “Big Beautiful Bill”—just before the July 4 deadline set by the president.

While its proponents claim it will make the country “stronger, safer and more prosperous,” leading health experts warn the bill is a dangerous and unethical setback for public health in the U.S.

With major cuts to Medicaid, significant changes to the Affordable Care Act (ACA), and reduced access to basic nutrition and reproductive services, the legislation’s health implications are vast and immediate.

What’s at Stake

At the heart of the bill is a $930 billion cut to Medicaid funding over the next decade—the deepest reduction to the program in its history.

In addition, for the first time, work requirements will be imposed on certain able-bodied adults aged 19 to 64 to retain their Medicaid benefits. Parents of children aged 14 and older must also meet this 80-hours-per-month rule through employment, training, volunteering, or school.

Dr. Jason M. Goldman, president of the American College of Physicians (ACP), as reported in healio.com, called the cuts “devastating” and warned they would cripple the U.S. health care system and worsen public health outcomes.

Similar concerns were echoed by the American Medical Association (AMA), the American College of Obstetricians and Gynecologists, and the Emergency Nurses Association, all of whom opposed the bill.

Dr. Arthur L. Caplan, founding head of the Division of Medical Ethics at NYU Grossman School of Medicine, called the bill “immoral, unethical, and tragic,” also reported in healio.com.

“Slashing Medicaid and imposing work requirements is punishing our poorest, most vulnerable, and mentally ill populations,” Dr. Caplan said.

“It’s unconscionable that the solution to economic reform is to cut basic health care.”

No Access To Affordable Care Act

The bill also weakens the Affordable Care Act (ACA), which could lower enrollment rates and disrupt access to care. One of the major changes is the elimination of automatic re-enrollment in ACA plans. Policyholders must now update their information annually, and the open enrollment window has been shortened by a month.

For individuals applying outside the open enrollment period—due to life events like job loss or family additions—advance premium subsidies will no longer be available immediately. Under current rules, applicants get up to 90 days of help while their paperwork is processed. The new law forces applicants to wait for full documentation approval before receiving assistance.

According to the Congressional Budget Office (CBO), the result will be catastrophic: an estimated 11.8 million more uninsured Americans by 2034.

“These patients don’t disappear,” Dr. Caplan said. “They flood emergency rooms with preventable issues—headaches, infections, chest pain—overburdening a system already stretched thin.”

Emergency Rooms on the Brink

With millions projected to lose insurance, ERs may become the default safety net—a role they are not equipped to handle.

“Hospitals will close. Services will shrink. Waiting times will skyrocket,” Dr. Caplan warned. “And it won’t just affect the poor—it will affect everyone.”

He also criticized the bill for ignoring the root cause of health care costs in the U.S.

“We have the most expensive, inefficient system in the world. Yet instead of tackling pricing, this bill cuts access,” he said.

SNAP Benefits, Nutrition & Health Impact

The bill also drastically alters the Supplemental Nutrition Assistance Program (SNAP), affecting roughly 42 million Americans. The age for work requirements has been raised from 54 to 64, and overall benefits will be reduced.

Many families will now receive less support—$292 for an individual and $975 for a family of four.

Nutrition is a cornerstone of preventive health, and public health experts say this rollback will contribute to higher rates of malnutrition, particularly among older adults and low-income families.

Reproductive Health and Planned Parenthood Defunded

In another blow to health access, the bill defunds Planned Parenthood, making it ineligible to serve Medicaid patients. According to the Contraceptive Access Initiative, 10% of Medicaid-covered women who received family planning services in 2021 did so through Planned Parenthood.

The move will severely limit access to contraception, STD testing, cancer screenings, and reproductive counseling, particularly in underserved areas.

Physician Payments, Rural Hospitals, and more

To soften the backlash, the bill includes a 2.5% temporary increase to Medicare Physician Fee Schedule rates in 2026, and reinstates certain telehealth flexibilities, as noted by the American Telemedicine Association.

However, experts like Dr. Caplan argue that these are inadequate responses to a much deeper crisis.

“That’s like saying the ship is sinking, but we’ve added two lifeboats,” he said. “Increased reimbursement won’t matter if your patient population loses coverage.”

A new UK-based study published in ERJ Open Research, has found that women who work permanent night shifts face a significantly higher risk of developing moderate to severe asthma compared to those who work during the day.

The findings add to the growing body of evidence that shift work, particularly night shifts, can have adverse effects on health—this time, with a gender-specific warning.

How Was The Study Conducted?

The study, conducted by researchers using data from over 280,000 participants in the UK Biobank, observed that 5.3% of the cohort had asthma, and 1.9% had moderate to severe asthma. Among these, female night shift workers stood out: those who worked permanent night shifts were found to have 50% higher odds of developing moderate-severe asthma than female day workers.

Interestingly, this association was not observed among male shift workers.

Circadian Disruption and Lung Health

Dr. Sunil Kumar K, Lead Consultant - Interventional Pulmonology at Aster CMI Hospital, Bangalore, explained how circadian rhythm disruption could increase respiratory risk.

“When our body’s natural rhythm is thrown off by night shifts or irregular sleep, it impacts not just our sleep cycles but also lung function,” he explained.

“The lungs don’t get the recovery time they need. Over time, this can impair breathing, reduce oxygen levels, weaken immunity, and elevate the risk of serious respiratory issues—especially in those already predisposed to asthma or COPD.”

The Hormonal Link

The researchers also suggested that hormone levels—specifically testosterone and sex hormone-binding globulin (SHBG)—may play a protective role against asthma. Women, especially post-puberty, tend to have lower levels of these hormones, possibly explaining their greater vulnerability.

Dr. Sunil noted that recent studies have reinforced the protective role of testosterone in reducing airway inflammation, which is a key concern in asthma management. “This could explain why asthma tends to be more severe in women after puberty,” he said. While hormone testing is not standard in asthma diagnosis yet, he believes that advancing research may soon shift clinical protocols.

Gender-Specific Vulnerability

The study further found that women who had undergone hysterectomies—with or without oophorectomies—also faced a higher risk of moderate to severe asthma, suggesting that hormonal changes could further exacerbate vulnerability.

“Female biology is more sensitive to circadian disruption,” Dr. Sunil pointed out. “Estrogen may worsen airway inflammation when sleep cycles are disturbed, while testosterone seems to offer some protection—something men naturally benefit from.”

He added that these findings should encourage workplaces to consider flexible schedules or regular lung health screenings for female night shift workers.

Underdiagnosed, Underdiscussed

Women working night shifts also reported more frequent symptoms such as wheezing or chest whistling and had greater odds of obstructed lung function compared to their male counterparts.

“In practice, we often see female patients with wheezing and breathlessness, but the link to lifestyle factors like night shifts is rarely discussed,” Dr. Sunil said. “These patterns are crucial for early diagnosis and management but remain under-addressed.”

Could HRT Be a Solution?

Given the hormone connection, researchers suggested that hormone replacement therapy (HRT) might be explored as a preventive measure for postmenopausal women doing night shifts.

“HRT could help balance hormone levels, protect lung function, and reduce inflammation,” Dr. Sunil said. “But it must be approached cautiously, given known risks like blood clots or heart disease. Tailored care strategies and careful risk assessment are key.”