Can pushing poop too hard lead to sudden death?

Have you ever had this experience: in the toilet, facing a stubborn "poop", you used all your strength, felt your heart was about to jump out, and even felt a little dizzy, and hoped that "hard work would work miracles", but it was still not enough? This is not a trivial matter! Some people have never been able to stand up again because of overexerting themselves... Oh, it's better not to talk about it, it's all tears!

The toilet, the most familiar but often neglected place in our daily life, actually hides many health risks. Especially for patients with cardiovascular diseases, the toilet is a potential danger area.

1. Scientific data warning

According to data from the U.S. Centers for Disease Control and Prevention, approximately 235,000 people are sent to the emergency room in the United States each year due to accidents in the bathroom. Among them, heart attacks caused by straining to defecate account for a certain proportion. The results of a Japanese study showed that among the 18,458 patients who suffered out-of-hospital cardiac arrest included in the study, 4.6% had cardiac arrest in the toilet, with an incidence rate of 4.5 cases per 100,000 people per year. In 2020, scholars from Beijing Anzhen Hospital affiliated to Capital Medical University found that ventricular free wall rupture is a fatal complication after acute myocardial infarction, and forceful defecation is one of the main causes of ventricular free wall rupture, accounting for as high as 37.9%.

According to a study published in the journal Chinese Emergency Medicine, 5,516 cases of sudden death after autopsy in my country were analyzed and it was found that some of them were related to straining during defecation, which is a major cause of sudden death. In addition, the international authoritative journal The Lancet also published a study that listed straining during defecation as one of the 10 lifestyle behaviors that lead to heart attacks, and ranked it second. These data show that there is indeed a certain correlation between straining during defecation and sudden death.

Tragedies happen and must be taken seriously. What is the science behind this?

2. Biomechanical Principles of Sudden Death Caused by Poop

Although pooping may seem simple, it is actually a technical and physically demanding job. You must first prepare your mood, adjust your posture, open and close your "chrysanthemum", squeeze hard, and then... you will feel refreshed and happy!

But, do you know that at the moment of squeezing, a "big earthquake" occurred in your body!

1. Pressure changes

When you push your poop hard, you often hold your breath, and your abdominal muscles will contract like a fitness coach, trying to squeeze out the "stubborn molecule". If you are interested, please follow my personal WeChat public account "Medical Biomechanics" article: Why do you hold your breath when you push?

When you hold your breath, the abdominal pressure will rise rapidly, just like blowing up a balloon. And when the abdominal pressure rises, it will cause trouble! It will run around like a naughty child.

Also, when you poop hard, the pressure in your chest cavity also rises. When the pressure in your chest cavity rises, your heart becomes more uncomfortable because it has to work under greater pressure.

2. Increased burden on the heart

When you hold your breath and strain to defecate, your abdominal muscles will contract strongly, causing a significant increase in abdominal pressure. This pressure change will affect the blood circulation system. Specifically, increased abdominal pressure will hinder the blood from the inferior vena cava and pelvic veins from returning to the heart, causing the heart to pump less blood. Think about it, the blood was originally flowing well in the blood vessels, but suddenly it was squeezed by this abdominal pressure, and the blood return was blocked. The heart has to work harder to pump the blood back. The heart is already busy like a spinning top, and now it has to work overtime. How can it not be tired?

The heart works hard to maintain blood circulation, which increases the heart's burden and myocardial oxygen consumption. For people with cardiovascular and cerebrovascular diseases, this extra heart burden may directly lead to myocardial ischemia, angina attacks or severe arrhythmias. In extreme cases, these heart problems may cause sudden death.

3. Blood vessel rupture and plaque detachment

The increase in intrathoracic and abdominal pressure will also reflexively stimulate vasoconstriction, and blood pressure will also rise like a rocket. When blood pressure is high, the pressure on the blood vessel wall is high. If the blood vessel wall is relatively fragile, it may break with a "pop"! If the ruptured part is in the brain or heart, it will be a big problem! You have heard of cerebral hemorrhage, right? The mortality and disability rate is extremely high (Figure 1)!

Figure 1 Pushing too hard can lead to serious consequences

In addition to the above mechanisms, straining during bowel movements may also cause sudden death by increasing the activity of plaques on the blood vessel walls. When blood pressure fluctuates greatly, the activity of plaques on the blood vessel walls increases, making them easy to fall off and form blood clots, which then flow everywhere with the blood. If it gets stuck in a narrow place, it would be even worse! For example, if it flows into the coronary artery and blocks the blood vessel, that is myocardial infarction! If it flows into the cerebral artery and blocks the blood vessel, that is cerebral infarction! Myocardial infarction, cerebral infarction, you have heard of it, it is a fatal disease!

So, you see, pooping too hard may actually be linked to sudden death! Of course, this doesn't mean that everyone will be like this, after all, our bodies still have a certain "shock resistance". However, for those who already have heart disease, high blood pressure and other diseases, then you have to be careful!

4. Analysis of special cases

To better understand the biomechanical principles of sudden death caused by excessive straining during defecation, we can look at some special cases.

For example, a patient in his 40s was admitted to the cardiac intensive care unit with acute decompensated heart failure. The patient had a history of distal coronary artery bypass grafting (commonly known as "heart bypass surgery"), heart failure with reduced ejection fraction, and insulin-dependent diabetes (in short, poor cardiovascular function). While defecating on a bedside toilet, the patient suddenly became dizzy and unresponsive, and eventually died of cardiac arrest. The doctor found through electrocardiogram analysis that the patient had bradyarrhythmia and hypotension during defecation, which may be related to increased parasympathetic nerve tone and sympathetic nerve contraction during defecation.

Another case was a case of an elderly person wearing a heart monitor who died suddenly in the bathroom. Doctors replayed the monitoring data and found that the elderly person's heart rate dropped significantly when he held his breath during defecation, and then suffered cardiac arrest. These special cases further confirm the potential threat of straining to defecate to heart health.

III. Prevention and Response Measures

Now that we understand the biomechanical principles of sudden death caused by excessive pooping, how can we prevent and deal with it? Here are some suggestions:

1. Maintain good bowel habits. Establishing good bowel habits is an important measure to prevent constipation and straining during bowel movements. It is recommended to have regular bowel movements every day and use physiological laws to establish bowel movement conditioned reflexes.

2. Scientific diet and moderate exercise. Scientific diet and moderate exercise are also important measures to prevent constipation and straining to defecate. It is recommended to drink more water and eat more vegetables, fruits, yogurt, milk and other foods that help to defecate. At the same time, moderate supplementation of dietary fiber can promote intestinal peristalsis and reduce the residence time of food in the intestine, thereby relieving constipation. In addition, moderate exercise can also enhance intestinal peristalsis and muscle tension and promote defecation.

3. Actively treat constipation. Constipation is a digestive tract disease caused by a variety of factors, characterized by hard and dry stools and reduced bowel movements. It is mainly manifested by abnormal bowel movements, including hard and dry stools, reduced bowel movements, and labored bowel movements, which affect the patient's daily life and quality of life. For people who already suffer from constipation, actively treating constipation is the key to reducing the risk of sudden death. You can take medication to relieve constipation under the guidance of a doctor, but be careful to avoid long-term use of laxatives to form dependence. At the same time, you can try to use external suppositories such as enema to assist defecation.

4. Pay attention to special groups. People with chronic diseases such as cardiovascular and cerebrovascular diseases and hypertension should pay special attention to their physical condition during defecation. These people are more likely to experience increased heart burden and high blood pressure when defecating, thereby increasing the risk of sudden death. Therefore, it is recommended that these people avoid excessive force when defecating and seek medical treatment for related diseases in a timely manner.

5. Provide a comfortable defecation environment. A comfortable defecation environment can reduce discomfort and tension before defecation, and help relieve constipation and straining during defecation. It is recommended to provide a quiet, private, well-ventilated defecation environment for defecation users, and equip them with comfortable defecation facilities.

Do you know the correct “posture” for pooping?

IV. Summary

In daily life, we may ignore the hidden health risks behind defecation, a seemingly normal physiological activity. However, through scientific research data and in-depth analysis, we found that excessive force when defecating may actually lead to sudden death. The biomechanical principles behind this involve pressure changes, blood circulation, increased heart burden, vascular rupture, and plaque shedding.

By understanding the biomechanical principles behind it, we can better prevent and deal with sudden death caused by straining to poop. Maintaining good bowel habits, eating a healthy diet and exercising moderately, actively treating constipation, paying attention to special groups, and providing a comfortable defecation environment are all effective preventive measures.

As I get older, my poop becomes a little distorted.

When I was a kid: I would poop, dig sweet potatoes, and catch grasshoppers at the same time - three birds with one stone. It was so much fun!

When you get old: clench your fist when you poop - exert force secretly. If you want to make miracles with great force, this is not the way to do it!

Tell your loved ones quickly that important scientific knowledge that may be overlooked in daily life can save lives at critical moments.