Everyone poops of course, but that doesn’t mean that everyone has the same pattern of bowel movements. The digestive tract is a complex system of organs, and there are many factors that play a role in bowel motility and consistency. What we eat and how much water we drink are two of those factors, but another one we don’t often think of is how long we “hold it in” when we feel like we have to go. While it’s certainly OK to hold it in for a while, doing so for too long can actually cause bigger problems.

Facts About Defecation

The main function of the gastrointestinal tract is to process the food we eat and intake necessary nutrients and energy. The process starts when we chew food, and then this mass of chewed food moves down the esophagus and into the stomach. In the stomach, gastric juices and peristalsis break down the food until it becomes a mostly liquid substance called chyme. The chyme then moves into the small intestine where digestive enzymes prepare it so that most of the useful components are absorbed.

From the small intestine, the remaining waste substance moves into the large intestine. Once in the large intestine, water begins to be absorbed while bacteria of the gut microbiome further process fiber and some other compounds that couldn’t be absorbed in the small intestine. This is also the site where stool begins to form. In normal circumstances, by the time the stool makes it to the rectum, it is a soft but solid substance. It remains in the rectum until it is ready to be passed through the internal sphincter, anal canal, and external sphincter.

As most people know from personal experience, however, it doesn’t always work that way. When bowel motility is sped up or slowed down, it can lead to unwelcome gastrointestinal symptoms. When motility is high, that means not enough water has been absorbed, and the person will likely experience diarrhea or loose stools. If the motility is too low, too much water is absorbed, and that results in hard stool that is difficult to pass; this is known as constipation, and it is often accompanied by bloating and cramping.

What Happens If You Hold It In Too Long?

The decision of when to poop is mostly governed by when it is sitting in the rectum and ready to be passed, but of course the body alerts us to this well before it needs to be passed. This gives us a window of time to find a bathroom. But what happens if you hold it in too long? And how long is too long? Naturally the answer is somewhat different for everyone, but there are some potential problems that can emerge if you go too long:

  • Chronic constipation: One of the most common side effects of holding it in for long periods of time is constipation. This is because when we clench the sphincter muscles, the stool gets pushed back into the rectum where it is again subject to water absorption. This makes the stool drier and harder to pass; if you regularly hold it in too long, it can eventually lead to chronic constipation.
  • Anal fissures: Another problem related to constipation is the possibility of anal fissures. When you hold it in too long and the stool becomes hard and dry, forcing it out can cause strain on the anal canal and even cause tears in the skin. In addition to pain, anal fissures also typically begin to bleed.
  • Fecal impaction: If holding it in too long leads to constipation, that means that stool remains in the rectum longer than normal. Usually this bulk is eventually passed (albeit uncomfortably), but in some cases it can develop into an immobile bulk that is essentially stuck in the rectum. This is called fecal impaction, and it can cause abdominal pain, bloating, and other possible symptoms.
  • Fecal incontinence: If fecal impaction isn’t treated, it’s then possible to develop rectal hyposensitivity, a lack of sensitivity to the presence of stool in the rectum. This loss of sensitivity is associated with fecal incontinence and the inability to control defecation. This may mean anything from total loss of control of the sphincter muscles to encopresis, a condition where liquified stool freely passes around the impacted stool and out the anal canal.
  • Gastrointestinal perforation: Another possible side effect of fecal impaction is a gastrointestinal perforation. One of the main ways this can happen is when the impacted feces causes tissue in the wall of the rectum to become damaged; in this weakened state, the tissue can tear and potentially allow fecal bacteria to leak into the abdominal cavity.
  • Hemorrhoids: Hemorrhoids are small veins that surround the anus and anal canal. Under normal circumstances, these veins and the tissue around them act as a cushion for defecation. In cases of constipation, though, the straining required to pass a hardened stool can cause the veins to become inflamed and swollen. This can happen with normal constipation or the kind that results from holding it in too long.

Most of the potential outcomes listed above are fairly rare and represent an outcome that would only happen in extreme circumstances. For instance, many people get constipated from time to time and aren’t really at risk of these other problems. There have been cases where holding it in too long has led to more serious condition, however. For instance, some studies have shown that fecal loading in the colon can raise the bacterial count and increase the risk of inflammation and diseases like colon cancer, appendicitis, and irritable bowel syndrome (IBS).

How Long Can You Safely Hold It In?

The truth is that there’s no universal answer for how long you can hold it in without causing a problem. Even with regular bowel movements, it can be significantly different from person to person, though the general range is three bowel movements a day to three bowel movements a week. It’s normal to hold it in for a while as you’re waiting for a bathroom to become available, but you should make a habit of listening to the urges from your body. Holding it in tends to be a bigger problem for young children who are still learning the norms for their own body and how to judge when they need to go.

Advice From a Board-Certified Gastroenterologist

Most people won’t need to worry about holding it in, but sometimes other gastrointestinal symptoms arise that don’t seem to make sense. If you’ve been experiencing new symptoms that are impacting your quality of life, it may be time to speak with a digestive healthcare professional. At Cary Gastro, we are dedicated to providing excellent care for any kind of digestive problem. If you’d like to get checked out, please contact us today to request an appointment.