Why strokes mostly occur in bathrooms, doctor explains

Dr Showkat Shah reveals link between bathing habits and stroke risk, shares prevention strategies

Stroke, a medical condition resulting in cell death due to poor blood flow to the brain, can occur anywhere, but the incidence of strokes is notably higher in bathrooms, according to Dr Showkat Shah, a critical care specialist and Medical Superintendent at Khyber Hospital in Srinagar.

Dr Shah, speaking to the news agency—Kashmir News Observer (KNO), explained that strokes are categorised into two main types: ischemic, caused by a lack of blood flow, and hemorrhagic, caused by bleeding. Both types can lead to impaired brain function.

"Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, feeling like the world is spinning, or loss of vision to one side that often appears soon after the stroke has occurred," he said.

However, it is a quite surprising fact that many strokes happen in bathrooms during a fresh shower, and there are several reasons behind it, as per different studies, he added.

The doctor said that studies conducted in this regard have shown that there is a rapid increase in bathing-related accidents, and it is mentioned that the primary causes of death while bathing are cardiovascular diseases, followed by cerebrovascular and respiratory diseases.

"Heart attacks that occur during defecation are, in many cases, the result of using (unnatural) sitting posture for waste elimination. Excessive strain during defecation adversely affects the cardiovascular system, resulting in syncope or death. Syncope is a temporary loss of consciousness usually related to insufficient blood flow to the heart," he said, adding, "Straining on the stool may reduce your blood pressure. This leads to an insufficient supply of blood to the heart. The use of a sitting toilet triggers the risk more than a squatting toilet, as it requires more strain. This is due to the rise in intra-abdominal pressure when straining to pass a stool."

Explaining further, Dr Showkat said, "Straining to have a bowel movement raises blood pressure. Someone prone to a stroke could push themselves over the edge in the process of defecating. This can cause venous backup and raise intracranial pressure; one cause of a 'stroke' is the rupture of a blood vessel. Raised intracranial pressure makes this more likely. It may trigger cardiac arrest in the bathroom often."

He said blood pressure is highest in the morning; this can be due to apnea or snoring. Then in the mornings, people go pushing stools when constipated, causing heart vessels to expand rapidly, bringing on heart attacks, he said. Adding water to the head first in showers is another trigger for a stroke, he added.

The doctor advised, "If you are older, then take blood pressure medication in the morning, shower one hour or later after medication, spray feet first, and work up to the head slowly with lukewarm water. Eat fibre or fruits so that no constipation occurs and avoid wetting the head and hair first during bathing to prevent abrupt changes in blood pressure."

For people with high blood pressure, sequenced bathing, the temperature of water, and season should be on the count, he said, adding that sudden cold water exposure increases sympathetic tone, which further causes a rapid fall in skin temperature and leads to rising blood pressure.

Dr Shah said a person with a history of high blood pressure or myocardial infarction must be careful about bathing as the difference in temperature in the bathtub and body could cause abrupt changes in blood pressure.

“While bathing or showering, do not wet the head and hair first. Sequenced bathing is very important to avoid such incidences. Start with wetting your legs and up to your head gently. Frequently, incidences of stroke, heart attack or cardiac arrest in the bathroom happen more in winter than in summer. Water temperature matters a lot while bathing," he said.

The doctor added that bathrooms can be places where individuals, especially the elderly, are at risk of falls and injuries due to slippery surfaces. "A fall can lead to head injuries, which in rare cases can trigger a stroke, and people might feel an increased urge to use the bathroom when their blood pressure rises, such as during intense straining while using the toilet. This straining can potentially elevate blood pressure and may be associated with an increased risk of certain types of strokes," he added.

The primary risk factors for strokes include high blood pressure, smoking, diabetes, high cholesterol, physical inactivity, family history of stroke, and other cardiovascular conditions, according to the doctor. "To reduce the risk of strokes, individuals should focus on maintaining a healthy lifestyle, managing underlying health conditions, and seeking medical care as needed," he said