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A Doctor Explains ‘Book Bowels’


Ask the Poop Doctor is a new column from Dr. Sameer Islam, MD, a Texas-based gastroenterologist who specializes in the diagnosis and treatment of diseases of the gastrointestinal tract. He also hosts segments such as Poop Tip Thursday and Let’s Talk About Poop on his YouTube channel. Have a question you’d like to submit? Leave it in the comments section below!

At some point in the mid-‘80s, the story goes, a Japanese woman named Mariko Aoki wrote a letter to a magazine confessing that she sometimes urgently felt the need to poop whenever she entered a bookstore. Aoki, it turned out, wasn’t alone: In the weeks that followed, many other people wrote in, explaining that they, too, felt the same urge in bookstores and libraries.

Likewise, the sensation became popularly known as the Mariko Aoki phenomenon—there’s even a lengthy Wikipedia entry about it, should you care to go even deeper down the rabbit hole (or the sewer pipe, as it were). And while Mariko Aoki phenomenon hasn’t been medically or scientifically proven, some doctors do say they have anecdotal evidence to support the connection between these quiet spaces and their ability to move your bowels.

“Oh yes, I’ve heard about this, and I have patients who’ve come to see me about it,” says Dr. Sameer Islam, MD, a Texas-based gastroenterologist and assistant professor of medicine at Texas Tech university. “It’s more common than people realize, and I think people are just embarrassed to talk about it,” he says. “I’ve also heard it called called ‘book bowels.’ I think that name speaks for itself.” We asked Dr. Islam what theories might help explain the strange phenomenon.

What mechanisms—psychological or otherwise—could explain why this connection exists?
It’s a purely psychological problem. Now, the people who experience this aren’t crazy or nuts. There’s a real connection between the gut and the brain—it’s called the gut-brain axis. What we feel mentally will affect our bowels. That’s why when you’re nervous, like taking a test or giving a public speech, you have butterflies in your stomach. It’s the nervousness you feel that corresponds to the butterfly feeling in your gut. For others, that nervousness will cause diarrhea and bowel issues to occur. It’s a common manifestation of conditions like irritable bowel syndrome.

Why bookstores or libraries specifically?
Actually, the urgency that people feel with bowel movements can also be found in other areas like parks and museums. The intensity of the information that you encounter in museums and libraries—or the sudden quiet of a garden—can trigger an autonomic response in your gut.

In a library or bookstore specifically, what’s likely happening is the effect arises from feelings of nervous tension in the face of all the information represented on the bookshelves. This has more scientific support and evidence, at least. But we really have no idea.

Some theories suggest that the smell of old paper or ink has a laxative effect, possibly due to the association of reading on the toilet.
It’s a possible theory, but we don’t have any scientific evidence of that. For “book bowels” specifically, possible theories include the smell of paper or ink having a laxative effect, the nervousness that may arise from all of the books present, the association with reading on the toilet at home, and the posture of browsing making bowel movement easier.

Another theory suggests that anxiety, conversely, may play a role—that if you’re nervous about the lack of availability of a bathroom, then your nerves, ironically, could wind up triggering your bowels.
I suspect this is more likely true than anything else. Many patients suffer from bowel issues like irritable bowel syndrome or ulcerative colitis—they are constantly worried about where the bathrooms may be. That can trigger anxiety, leading to diarrhea and pain.

Too many of us also read in the bathroom, which, in and of itself, causes lots of bowel issues—hemorrhoids, pain, fissures, etc. And over time, your colon and body will associate reading on the toilet with using the restroom. That subconscious connection will give you the urge to poop when you are around a bathroom.

One more: Others feel it might have something to do with posture when browsing books—the way people hunch over to read the title on the spine. Does that sound plausible to you?

That’s not far-fetched at all. Your posture makes a huge difference when it comes to pooping. That’s why things like squat-a-potties work—they change the rectum’s angle to make it easier to access and easier to leave. The same can be with stooping over when reading a book on the toilet.

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