Can straining to defecate be lethal?

Question

Elvis Presley and Don Simpson famously died going to the loo. However, both were heavy drug users, which was in both cases determined to have been the cause of death.

However, this hasn't stopped the pop-culture memetic mutation making it sound like they died due to on-potty overexertion.

Perhaps most famously, The Sopranos' episode He Is Risen involves a heart attack while pushing to poop. The TVTropes article Undignified Deaths includes a few more, and asserts that “hundreds of people die each year by straining so hard to get a poo out, they burst a blood vessel in their brains”. The source of the statistic is not given.

Various other such cases can be found in the Wikipedia article Toilet-related injuries and deaths.

Does this actually happen? What injury exactly does it cause? How common is it?

Answer 1

Death can occur if the fecal impaction is not promptly relieved through defecation since the condition can lead to colonic perforation (hole that develops through the wall of the small intestine, large bowel), peritonitis (inflammation of the peritoneum which is a thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs), and patient demise in cases of stercoral peritonitis. Per Lawrence Leung et.al. in 2011, patients often equate constipation with straining and urge for defecation. One of the complications of Chronic constipation are hemorrhoids caused by prolonged straining and increase of intra-abdominal pressure raises the venous pressure in the plexus and ateriovenous anastomoses of the anorectal junction.

Lethality of Stercoral peritonitis: When extremely impacted feces (fecaloma) compresses the colonic wall, it might cause ischemic ulcers, subsequent perforation, culminating in stercoral peritonitis and sometimes death. However it is not a common condition since death is reported in fewer than 90 cases in medical literature from 1894 to 2006 who was known to have stercoral peritonitis.

The Rome III criteria in 2006 defines constipation as having at least 2 of the following:

(1) straining during ≥25% defecation

(2) lumpy or hard stools in ≥25% of defecation

(3) sensation of incomplete evacuation in ≥25% of defecation

(4) sensation of anorectal obstruction/blockage in ≥25% of defecation

(5) need for manual maneuvers to facilitate in ≥25% of defecation

(6) fewer than 3 defecations per week.

Regarding Elvis death in the bathroom, "Elvis' personal physician, Dr. George Nicopolous, wrote in his 2009 book, The King and Dr. Nick that "We believe Elvis died from a normal physiological event brought into play called 'Valsalva Maneuver.' This caused the heart to stop when the body strained. When Elvis compressed his abdominal aorta by straining, his heart, in response, went into arrhythmia and quit working suddenly." According to Guralnick, "the large intestine was clogged with fecal matter, indicating a painful and longstanding bowel condition. The bowel condition alone would have strongly suggested that drug use was heavily implicated in this unanticipated death." Regarding the death of Don Simpson, "an autopsy and toxicology report later determined that Simpson had died of heart failure caused by combined drug intoxication (cocaine and prescription medications). At the time of his death, there were twenty-one different drugs in his system including antidepressants, stimulants, sedatives, and tranquilizers."