It's a fact of life that everyone poops. In fact, regularly emptying your bowels is pretty much a prerequisite for good health. With that in mind, imagine all the problems that could arise if you were so stopped up, you couldn't go for months. That scenario ended tragically for Emily Titterington, a 16-year-old from Cornwall, England, who died on February 8, 2013, after not pooping for eight weeks. Emily, who had mild autism and had dealt with bowel issues for most of her life, reportedly had a fear of toilets so severe, it led her to withhold stool until it became life-threatening. According to the medical inquest into her death, she suffered a fatal heart attack as a result of her enlarged bowel, which shifted around and compressed some of her organs.
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Emily suffered a "massive extension of the large bowel," says pathologist Amanda Jeffery in The Independent. Paramedic Lee Taylor, who saw Emily twice on the night of her death, noted that "her abdomen was grossly extended. Her lower ribs had been pushed out further than her pubic bone." The sad part is that Emily didn't have to suffer that way. "Her death could have been avoided with the right treatment at the right point," her general practitioner, Alistair James, told The Independent. He'd prescribed laxatives, but beyond that, Emily refused medical treatment, reportedly due to a fear of examinations.
"I've never heard of this happening before," says Frank R. Malkin, M.D., a gastroenterologist at Charles River Medical Associates in Natick, Massachusetts. "It's not uncommon to see young people in their teens or twenties come in and say they haven't gone to the bathroom in two weeks, but they can take stool softeners or fiber pills, or we find some other form of treatment if necessary. Eight weeks without going to the bathroom, then dying from that, is very unusual." But when extreme stool withholding does happen, it's almost never with adults.
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"This is absolutely more common in children," says Carin Cunningham, Ph.D., a pediatric psychologist at Seattle Children's Hospital who hasn't seen a death from constipation in her time specializing in gastroenterological issues but can understand the mechanism behind it. "It's typically a pain response to severe constipation. A child will be afraid to stool, and instead of opening the external anal sphincter muscles, they'll contract them. It becomes habitual.
"Sometimes, the toilet becomes associated with stooling, so there's a toilet phobia. Many kids who have a fear of the toilet will still soil themselves, but in some cases, the colon becomes distended and the body just accommodates all that stool retention." When you add in mild autism, which can boost a person's pain threshold and make someone less connected to what's going on inside his or her body, it's potentially a recipe for disaster.
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The good news is, it's highly unlikely you'll deal with constipation of this sort after you age out of childhood. "This is most common when children are about two and a half to five years old," says Cunningham. "By age 16, less than one percent of people experience this because adults know they should be stooping for a regular basis and will realize something is wrong." Even though the probability of stool withholding dwindles as you age, you should still be on the lookout for regular constipation, especially if your new schedule is deviating from your norm. "Everyone is different," says Malkin. "Some people go once a day, others go two or three times a day, and some people go every three or four days. If your normal routine changes, then it's time to see a doctor." They'll likely offer up these easy fixes for constipation or make another suggestion to help you keep your system chugging along smoothly.
