Morning Poop

"Time to poop!!!"

For health care professionals, the morning poop is a daily event as important as teeth brushing or wearing pants.^[1] Studies have shown that without a good morning poop, workplace productivity plummets and people describe their mood as “irritable” and “bloated.” In this article, we will explore the morning poop tradition and help facilitate the perpetuation of this important ritual.

Pathophysiology

From a pathophysiologic standpoint, poop descends into the rectal vault immediately upon awakening. As the volume of poop expands, stretch receptors competitively inhibit axon firing in the frontal lobe. The speed at which this occurs is multifactorial, based on a variety of genetic, environmental, and coffee-related factors. This inhibition results in slowed cognition as well as the all-consuming thought, “I really need to poop.” Once the poop is released from its intestinal prison, all higher order thinking and medical decision-making are able to return.

History

The historical significance of the morning poop dates back to the time of Hippocrates around 400 BC. The Greek scholar famously stated, “Make a habit of three things: To help, to do no harm, and to poop every morning.” In fact, most of the Hippocratic Oath was written while pooping. Of course, the ancient Greeks had no toilets, so Hippocrates had to etch his oath into limestone tablets while squatting over a hole in the ground, the exertion required no doubt facilitating the evacuation of his bowels.^[2]^[3]

Timing

The timing of the morning poop varies by individual, with the most common contributing variable being stress level. Surgeons nervous about a particularly difficult case that day may poop immediately upon waking, and on rare occasions poop in their pajamas right before their alarm goes off, known as adult nocturnal pooping syndrome (ANPS). On the other hand, providers in low-stress specialties like pathology or whatever PM&R is may not notice an expanded rectal fault for hours. The important thing to recognize is that your own time-to-morning poop (TTMP) may be an indicator of stress.

Location

Another important consideration is where to have your morning poop. Sometimes circumstances preclude your ability to choose a pooping location, such as chronic adult nocturnal pooping syndrome (CANPS). For the average health care worker, there is plenty of time to plan the location of your morning poop. There are two schools of thought: public versus private. That’s right, the same basic dichotomy governing school choice for kids applies to where your morning poop will be received. Many people only feel comfortable pooping in the safety and privacy of their own home. There is certainly merit in this decision. The home toilet is familiar and can serve as a calming influence during toilet time.

However, restricting oneself to home base for defecation can present major hurdles. Occasionally, the need to poop occurs on the way to work when returning home is not a reasonable option. It’s important to maintain the flexibility and confidence to poop in a public location. For many doctors and nurses, this means navigating the harrowing world of public hospital bathrooms.^[4] This is a great option for early risers like surgeons, residents, and med students. Arriving at the hospital before 7 AM affords the luxury of being the first person to use any given public hospital toilet that day. This point cannot be overstated. Not only do you get the extravagance of a powerful motion-sensored flush, you get a clean bowl and a fully stocked toilet paper dispenser.

Now, those who arrive after 8 AM have a more difficult pooping task ahead of them. The toilets near the hospital main entrance are out of the question. By this time, the incontinent elderly have arrived for their appointments. You must look harder for a suitable location to have your morning poop. Most locations inaccessible to the public behind locked doors are reasonable options. The one exception would be the OR locker room on a busy ortho day. If you are lucky enough to have unfettered access to the hospital administration office suite, take full advantage of their facilities. Most admin bathrooms have a person who will wipe your ass with Charmin extra soft.^[5]

The Night Shift

What if you work nights or have a string of night float? Does the body transfer morning poop to the evening? Not enough research has been done to determine the effect night shift work has on morning poop physiology. Case reports suggest the body becomes confused and decides to stop pooping altogether, a condition known as night shift constipation (NSC). This is why health care professionals working overnight are encouraged to adopt a “One for You, One for Me” policy when administering chronically-constipated patients Colace or any kind of enema.^[6]

What is the Platonic Ideal of Morning Poop?

Evacuation occurs the moment cheek hits toilet, no sooner, no later
Large
Swift
Drop one pants size upon completion
No wiping
Post-poop clarity

Helpful Tips

Plan to drink your coffee 15 minutes before you’d like to poop. Coffee gently tickles the large intestine, making it laugh so hard it pushes poop through the anus.^[7]
Patient care can wait until you have completed your morning poop. However, don’t tell your patients you have to poop. Many of them are under the impression we don’t have bowel movements.
Don’t bring reading material into the stall with you. Instead, use your smart phone to answer emails.^[8] The smart phone was God’s gift to morning poopers.
It’s ok if somebody enters to stall next to you to have their morning poop. No talking is necessary. Just appreciate the solace and quiet companionship of both of you taking care of business.

Related Reading

- Bowel Prep

- Colonoscopy

- Constipation the Movie

- Coumadin (Warfarin)

- Craptastic

- Digital Cable

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