Elena Scotti/FUSION

Nearly forty years ago the world was forever changed with the publication of the book Everyone Poops. With his frank talk and adorable illustrations, Japanese children’s book author Tarō Gomi took a weight off our collective shoulders by bringing this universal truth out of the shadows, helping adults and children alike admit that all of us are programmed to defecate.

But for some, that admission is still not so easy.

Earlier this month, a first-person essay published on Cosmopolitan’s website made waves when its writer, Mary McClelland, admitted: “I Refuse to Poop or Fart in Front of My Partner.” In the story, she says, “I don't even think he knows I poop!”

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This got many of us wondering: How has McClelland managed to pull that off during two years of dating and seven years of marriage? While she doesn’t specify, we can infer that she’s constantly having to conceal her bowel movements (also known as “holding it in”).

While most of us haven’t found themselves in the exact same situation as McClelland, many can surely relate to the temptation to conceal bodily functions from a love interest (or friend or relative or coworker). But when we defy nature, could we be putting our health at risk?

Dr. Kyle Staller is a gastroenterologist at Massachusetts General Hospital, where he treats a range of gastrointestinal issues in addition to conducting research on constipation. When I told Staller about the Cosmo writer’s story of holding it in, he was unfazed. With a predominantly female patient roster, he’s no stranger to talking through bowel shyness.

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“The body is really meant to effectively evacuate waste,” Staller said in a phone conversation. “It has a natural rhythm that helps people do that.” He says that rhythm is different for everyone and “there’s a varying spectrum of what normal is.” The problem is that humans are able to impact their natural waste management through certain behaviors—like holding it in.

“What can happen is if you, over time, voluntarily prevent [bowel movements] from happening, the body recognizes this as a “new normal” and starts to have dysfunction in the way the pelvic floor muscles work,” Staller says. This leads to pelvic floor dysfunction, meaning that the signals that lead you to poop get thrown off. It can also slow down your colon as it matches the pace at which you’re defecating.

To put it simply: When you gotta go, you should really go.

Waiting too long to go isn’t the only behavior that could potentially lead to gastrointestinal problems: Not taking enough time to poop also puts you at risk. If you’re waiting for your significant other to run to CVS for a pint of Ben and Jerry’s and a box of condoms so you can do your business, tapping your foot and stopping as soon as you hear the front door click, you’re not doing your body any favors.

The impact of pelvic floor dysfunction isn’t fatal, but can certainly lead to issues like chronic constipation. The good news is that it’s treatable using laxatives or, in more severe cases, sessions with a pelvic floor physical therapist. Staller calls this work “remarkably effective” but “very intimate.” The physical therapist takes a close look at your bowel behaviors and helps you evaluate defecating techniques. But hopefully you’ll never reach this point.

Reading all this might make you feel a bit paranoid that every time you hold it in on the train or during a movie you’re doing irreversible damage to your G.I. tract: Staller assures that this is not the case. “But people who make a habit of it over the course of years…those are people who are potentially at risk of having this happen.”

For example, if you’ve been married for seven years.

In my phone conversation with Staller, aside from learning a whole lot about our digestive tracts, one thing becomes very clear: Societal pressures on women have more than likely resulted in increased female constipation. Staller says that his research and experience have shown that women experience constipation by a factor of two to one over men, and he suspects it’s no coincidence.

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“I think the classic patient that is afraid [of defecating] is a young woman who’s in a relationship—especially a newer relationship or a newer marriage—where they feel that need to leave a lot of mystery,” Staller says. “Bowel movements are something that are inherently embarrassing yet inherently important.”

The same can be said for passing gas, although holding in farts is much less likely to cause serious complications.

Staller’s research uses the biopsychosocial model, which is essentially the way that the body’s actions are impacted by our behaviors and surroundings. It’s through this lens that he sees a pretty obvious link between how women are expected to behave and the gastrointestinal problems they develop.

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“I think the pressures right now, despite the gains that have been made in gender equality, is that a lady is still expected to be proper or not pass gas,” Staller says. “Even … people who are high-powered and high-functioning, they’re still subject to these societal rules, whether they’re fair or not.”

On the flip side, he’s seen that male patients and men in general are much more proud of a healthy bowel movement. “Or at the minimum, not ashamed of them,” he says.

It’s also no coincidence, from Staller’s perspective, that professions in which holding it in is an occupational hazard—like nursing, teaching, and social work—are female-dominated fields. What else do all of these fields have in common? Well, for one, they require the practitioner to put others' needs before hers. And Staller has seen that nurses, teachers, social workers, and the like are prone to constipation issues.

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Apart from being a symptom of societal pressure, though, on a more personal level, constipation and bathroom shyness say something about the dynamics of a relationship and how a woman perceives her role.

“Many women I treat are often in these relationships that don’t actually acknowledge bowel movements in front of their significant others,” Staller says. “The advice I often give to them is: You don’t need to celebrate your bowel movements. [But] it is something that you should be at least acknowledging so you can be healthy.”

In a 2008 episode of 30 Rock, the character of Jenna, played by Jane Krakowski, tells Tina Fey’s Liz Lemon that true love is “hiding who you are at all times. It's wearing makeup to bed and going downstairs to the Burger King to poop."

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But what I’ve learned is that actual true love means being upfront about your body’s movements—bowels and all.

Marisa Kabas is a Sex + Life reporter based in New York City. She loves baseball, bunnies and bagels.