Yes, our toilets will soon be smart too

Although there are many physicians that make people question the following, doctors are human beings too. I say this because many doctors are uncomfortable with certain topics which are considered impolite in people’s usual conversations. Considering how much is being written about the need to address the risk of bowel cancer, as a leading cause of death at least in the westernized world, it is strange that most people are still generally very uncomfortable talking about bowel function. I have had many patients apologize for mentioning their bowel function even when I specifically would ask them about it, as part of their medical history.

Constipation is a potentially very severe disease. It can cause chronic severe pain, lead to general alterations in nutrition, definitely screw up the normal microbiological environment in the bowel and lead to a tremendous overuse of over-the-counter medications to self medicate this problem away. In a recent paper I was just reviewing this morning, the authors reviewed the medical literature on this topic and included a further study that actually failed to clearly identify a root cause for constipation amongst admitted patients in the hospital. The conclusions of the authors were ones that are presently often quoted, namely, to increase fiber intake  and to use appropriate laxative agents. What struck me about this study was that the patient population studied was very small due to the specific parameters required for inclusion in the study.

I have discussed the potential of smart watches and other wearables as a replacement for the type of research that is presently done. Interestingly, I think that the study of constipation is a classic example of how constant monitoring of various daily behaviors can provide the critical information necessary to understand why our bodies fail to function appropriately. In order to really understand why a person would develop constipation, one really needs to know a great deal.  Sleep patterns, dietary patterns, amount of time sitting at one’s desk, level of physical activity, alcohol intake and so much more can contribute to (ab)normal bowel function. Opiate medications [morphine and its derivatives] are well known for their constipating effect. I unfortunately have a great deal of experience with the side effects of opiates as pain management is a big part of my daily life.

The authors, of the study I mentioned above, note that a clear correlation between opiate use and in-hospital constipation is not  well demonstrated in the medical literature. I smiled when I read this because from personal experience, it is absolutely clear to me that long-acting opiates [the kind that slowly release over the course of many hours] are much more effective at controlling my pain but are also unfortunately much more effective at interfering with my normal bowel function. When I use short acting opiates, my pain control is definitely less effective but I do not suffer the same complications. From my single case, anecdotal study, I would argue that any long acting opiates that never give the bowels a break, are specifically problematic. In a hospital environment where patients may very well be receiving pain control around-the-clock, one has a similar situation – that the bowels are never given a chance to reactivate.

Our toilets are actually a tremendously missed opportunity to learn a great deal about our body’s functioning. A detailed urinalysis can provide a tremendous amount of information about a whole range of diseases. Changes in urinary output can be the first sign of a failing heart. Of course, other changes in urinary frequency, quantity and composition can indicate various types of renal failure. Studying the output from our bowels gives us a tremendous amount of information about our bowel micro biome which has been recognized as critically important for normal health. Frequency, consistency and many other characteristics of our bowel output can all be linked together to give us a very detailed picture of our health. Smart toilets that can do all of this analysis and then save it to our online persistent medical record, will become standard in the years to come, both in hospitals and at home.

Unquestionably, many people will find this further form of intrusiveness to be, well, intrusive. People will prefer staying ignorant to their health and will also prefer missing an early diagnosis of cancer rather than having to think about such disquieting things. Of course, people won’t have to think about these things because this will just be another gadget or intelligent piece of software and hardware that constantly works in the background to protect us as much as possible. And in the event that an individual does need health care in the hospital, the computer will already warn the staff as to the risk of this patient acquiring constipation.

In terms of general research, by studying the entire background history of a person and then comparing it to their bowel function, we will very quickly be able to identify the specific causes of constipation in a given person. This will be another example of totally personalized healthcare which is unattainable without smart watches, smart clothes and smart bathrooms.

Just yesterday, I was reading about an Israeli innovation that could allow for the early detection of bowel cancer by virtue of a simple blood test. It is astonishing how quickly we are advancing to a point where minimal specific actions on our part will be required to build an entire health profile of ourselves, and thereby identify any looming risks.

I live with pain and I live with the side effects of the medications I take for that pain. Many people don’t have the luxury of avoiding discussing such awkward topics. I look forward to all of these innovations, and I hope that they will help people avoid so much unnecessary suffering.

Thanks for listening


About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.