While the title of this article mentions cardiac arrest, any type of cardiovascular emergency can occur in a bathroom setting. You will hear me talk about cardiac arrest and also heart attack and stroke throughout this article.
These are similar but very different cardiac emergencies. However, the suggestions provided may help reduce your risk of any cardiac events from occurring.
>>To skip to a handy infographic on how to avoid cardiac emergencies in the bathroom, click here.<<
Table of Contents
What is a Cardiac Arrest?
A cardiac arrest is a serious heart event that can happen anywhere. It is defined as a sudden loss of heart function, breathing, and consciousness. This event can be deadly if proper action is not taken as soon as possible.
Other names for cardiac arrest include heart arrest, cardiopulmonary infarction, and asystole.
In contrast, a heart attack is when blood flow to the heart is blocked. There is no loss of heart function, breathing, or consciousness. Although, it is important to note that a heart attack can lead to cardiac arrest.
Why Do They Happen in the Bathroom?
You may not feel very stressed when taking a bath, shower, or having a bowel movement. But these everyday routines CAN put stress on your heart and body. This excess stress may lead to a syncopal episode, cardiac arrest, stroke, or even death. Additionally, this risk is higher in the elderly and those with a history of cardiac issues.
Toilet Straining
Of all cardiac arrests reported, 8-10% of these occur while on the toilet.
Having a bowel movement requires you to use certain muscles in your colon and rectum. I’m sure you’ve heard that straining to get a bowel movement out is something you should NOT do. This is 100% correct.
With that said, straining happens for many different reasons, including:
- changes in breathing (AKA the Valsalva maneuver)
- using unnatural sitting position
- constipation
Changes in Breathing (the Valsalva Maneuver)
If straining on the toilet, you are likely using a maneuver called the Valsalva maneuver.
This maneuver is a breathing technique that is sometimes used to correct abnormally fast heart rhythms. However, it should not be used when attempting to have a bowel movement.
This is because it uses forced expiration, similar to what you do when blowing up a balloon. You inhale first. Then when exhaling, you try forcing it through a closed glottis. This adds pressure on your chest, heart and blood vessels.
After finally releasing a bowel movement, you exhale and your colon and rectal muscles relax. This sudden relaxation triggers your vagus nerve. This results in a drop in blood pressure and heart rate. And the resulting event of fainting , stroke, heart attack, or cardiac arrest pursue.
Unnatural Sitting Position
Believe it or not, there is an efficient and effective way to sit while relieving yourself.
If you sit upright at a 90 degree angle, you will likely end up using the Valsalva Maneuver described above. Your parents may have told you to sit up straight, but this does not make the process of elimination easy. This is because a “sitting” position does not fully open your rectum, making having a bowel movement more difficult.
Instead, try a squatting position. Lean forward slightly at a 30 degree angle, with your knees above your hips. It may also help if you elevate your feet on a step stool or some books.
Research reports that using this position may make elimination quicker and more convenient. Additional health benefits of this position include:
- preventing against stretched or damaged pelvic nerves
- maintaining continence
- preventing and treating hemorrhoids
- making it less likely to get hernias
- making childbirth easier for females
Constipation
Another study assessing people in a hospital setting suggests that cardiac arrests happen in a bathroom setting due to “increased emphasis on early mobility, constipation, or medications such as opiates”. Opiates are a type of medication used to control pain. They are known to cause constipation.
If constipation is not a usual occurrence for you, you may be able to prevent it by adjusting the amount of fiber and fluid in your diet. But keep in mind that constipation may also be a symptom of other health conditions such as:
- Thyroid issues
- Micronutrient deficiencies
- Medications that list “constipation” as a side effect
- Hormonal imbalances
- Increased stress
For information on a high fiber diet, print this PDF handout on a high fiber diet from the University of Virginia’s GI Nutrition Department.
And if you feel that constipation is a chronic issue or there is any cause for concern, speak with your doctor. He/she may have you try stool softeners, laxatives, or refer you to a registered dietitian for more individualized dietary care.
Water Temperature
The temperature of your bath water is also very important in preventing heart issues. Most research suggests keeping water temperature between 90 degrees and 105 degrees Fahrenheit. This can improve arterial stiffness and increase blood flow. In fact, regularly bathing shows some promise in the prevention of atherosclerosis and preserving heart function in the elderly.
According to some studies, the benefits are due to the warm temperature of the water. And not so much the actual submersing yourself.
There are some precautions however when it comes to water temperature. You must make sure not to make water temps too hot or too cold. Higher temperatures can cause overheating or a drop in blood pressure. And colder temperatures can constrict blood vessels, preventing enough blood from getting to your heart and brain.
Water Pressure
Submersing yourself in water when taking a bath can also have risks. When in a bathtub, the water’s pressure around your body can cause a shift in your blood flow. Blood will begin to shift from your extremities (legs) to a more central location (heart).
This sudden shift may increase your risk of stroke, reduce heart rate, and cause your heart to pump harder. Although research on this topic is conflicting. For example, some studies show benefits of hot water bathing. Yet others report an increase in cardiac complications.
My advice is to ensure that the water’s temperature is between 90 and 105 degrees Fahrenheit as mentioned above. Also, if you choose to take a bath, ease into the tub slowly so the pressure doesn’t hit you too quickly.
Air Temperature
The temperature of the air can also determine risk for cardiac arrest in the bathroom.
It is a fact for most people that the temperature in your bathroom is often cooler than the rest of your house. Conversely, the temperature of the water in your bath or shower may be quite hot. The greater this difference is, the higher your risk for a cardiac emergency.
Findings from one Japanese study show that cardiac arrests occur most often in the colder winter months and also when victims submerge their faces in the hot water.
Thus, in order to prevent cardiac issues for yourself, try:
- decreasing the difference between the temperature in your bathroom and the temperature of your bath/shower water
- refraining from taking long baths in hot water
- Only filling the tub halfway, to mid-chest height.
Sequence of Bathing
Although you may have heard about a specific sequence of bathing such as starting at the feet and working your way up, there is no scientific evidence to confirm that this reduces cardiac events from occurring.
Yet science does suggest half-body bathing to improve circulation over full-body bathing. This means that when taking a bath, try filling the water up to the middle of your chest. And avoid submerging your whole body or face.
Half-body baths are not only more superior to full-body baths, but also to showering. This is because bathing with water up to your mid-chest helps increase circulation and blood flow better than other options.
Why are Heart Attacks in the Bathroom More Dangerous?
Having any type of heart-related emergency is a scary and dangerous situation. Heart-related emergencies in a bathroom setting however, are at a whole other level of dangerous.
You Are Alone
This may be the most obvious reason for being more dangerous. More times than not, while going to the restroom, you are by yourself. Adding to that, you will most likely have the door locked. This is, after all, a very private setting.
This occurrence is extremely dangerous, as you have no one present to witness the event and call 9-1-1. In this case, your chances of survival are slim to none.
Help is Delayed
In other instances, help is present, although delayed.
If you do happen to live with others, it may take them time to figure out that help is needed. This is a scary situation, as some cardiac events are very time sensitive.
Preventing Heart Attack in the Bathroom
Signs You May Need Help
It is crucial to familiarize yourself with warning signs of a cardiac event.
The very second you begin to experience any of the following, you need to get help immediately:
- Chest pain
- Nausea or vomiting
- Dizziness
- Palpitations
- Shortness of breath
You should also keep in mind that men and women have different signs and symptoms of cardiac arrest.
Men more often experience chest pain, while women report shortness of breath. This can be different for everyone though.
Develop an Action Plan
Even after following all the above recommendations and suggestions, an emergency may still occur. So, having a clear plan of action is always a good precautionary measure. In this case, it could save your life.
Whether you live alone or with other people, there is always something you can do to decrease your risk and increase your chances of survival.
If You Live Alone
First off, while studies show that the likelihood of you calling for help or utilizing a life alert system may be slim during a cardiac emergency, it is still a good plan to have in place. If you start having symptoms, you may be able to alert someone before fainting or becoming unconscious.
Secondly, living alone doesn’t mean people can’t check on you. Recruiting family or friends to call every hour or a few times a day is a great way to make sure you’re safe. Some people even rely on neighbors who are close by, in case of an emergency. For family members that live out of town, calling your loved one’s neighbor may also be an option for physically checking in.
And third, keep your bathroom door unlocked. If you live alone, there is no need to fear someone walking in on you. An unlocked door means help will be able to reach you in less time.
If You Live With Others
Living with others while being an at-risk individual is very much to your advantage. First of all, not only do you have someone available to hear if something is wrong, you also have someone to get help quickly.
Have them check on you if you’re taking too long in the bathroom. If they hear any loud noises, or if you’ve been silent for too long, have them check on you.
Additionally, have those you live with learn CPR and how to use an automated external defibrillator (AED). They can attend in-person classes through their local American Red Cross location or even online through the National CPR Foundation.
I would highly recommend attending live classes. By choosing the in-person route, you can learn and practice CPR and how to use an AED device first-hand. You can also get any questions answered right away.
You may even purchase an at-home AED. There are many AEDs available at competitive prices, including refurbished ones.
Here is a handy infographic on how to avoid cardiac emergencies in the bathroom. Save, print, and share with others who may need it.
Conclusion
Overall, my recommendation is to take precautions if you feel you are at risk of a cardiac event while in the bathroom. And remember that the extent is greater in the elderly or those with a history of heart issues.
Don’t ever strain when using the toilet and make sure you are sitting (or squatting) properly.
Be careful of not only water temperature, but also room air temperature prior to submersing yourself in the water.
And finally, make sure loved ones are aware of the possibility of a cardiac event happening in the bathroom. If you live with other people, develop a plan for physically checking in. And if you live alone, have someone call or visit regularly or contact help once symptoms begin.
With proper planning, you can save your life or the life of someone you love.
For more information on how to live a cardio-protective lifestyle, read my article “5 Things You Can Do To Support Heart Health NOW!”.
References:
- Inamasu J, Miyatake S. Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles. Environ Health Prev Med. 2013;18(2):130-135. doi:10.1007/s12199-012-0301-y.
- Ryu SJ, Lee DH, Lee BK, et al. Water Temperature Variability Is Associated with Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management at 33°C. Published July 16, 2021. Ther Hypothermia Temp Manag. 2021;10.1089/ther.2021.0011. doi:10.1089/ther.2021.0011.
- Tyagi, Beitler J, Sell R. Commode Codes: Toilet Related Cardiac Arrest and Telemetry Monitoring. Amer Journal of Resp Critical Care Med. 2018; 197:A3319.
- Srivastav S, Jamil RT, Zeltser R. Valsalva Maneuver. [Updated 2022 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537248/
- Kohara, K., Tabara, Y., Ochi, M. et al. Habitual hot water bathing protects cardiovascular function in middle-aged to elderly Japanese subjects. Sci Rep 8, 8687 (2018). https://doi.org/10.1038/s41598-018-26908-1
- Bhattacharya S, Chattu VK, Singh A. Health promotion and prevention of bowel disorders through toilet designs: A myth or reality?. J Educ Health Promot. 2019;8:40. Published 2019 Feb 15. doi:10.4103/jehp.jehp_198_18
- University of Virginia School of Medicine. Increasing Your Fiber. Patient Education. Accessed May 7, 2022. Available at: https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2021/07/Increasing-Your-Fiber-7-2021.pdf
- Tahara Y. Association between bathing and sudden death. Circ J 2017;81(8):1096-7. Accessed May 7, 2022. Available at: https://www.jstage.jst.go.jp/article/circj/81/8/81_CJ-17-0673/_html/-char/en
Kiran Campbell is a registered dietitian and entrepreneur with 13 years of experience. She has a degree in psychology as well as dietetics. She is also a proud member of the Academy of Nutrition and Dietetics’ and its Cardiovascular Health and Well-being Dietetics Practice Group among others. Kiran proudly presents and promotes the most up-to-date, science-based nutrition information on all things heart-related. She aims to serve not only individuals with heart disease, but also those wanting to protect against it. Learn more about Kiran by visiting her About Page.