Beyond Total Screen Time: The Strong Association Between Toilet-Related Smartphone Use and Functional Bowel Disorders

Beyond Total Screen Time: The Strong Association Between Toilet-Related Smartphone Use and Functional Bowel Disorders | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Beyond Total Screen Time: The Strong Association Between Toilet-Related Smartphone Use and Functional Bowel Disorders Beril Demir, Halit Kandemir, Enes Comert, Derya Kirman, Ali Karatas, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9279150/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background/Aims: Screen-based sedentary behaviors have been increasingly implicated in functional bowel disorders (FBDs); however, the role of contextual screen use, particularly during defecation, remains unclear. This study aimed to evaluate the association between total screen time, toilet-related screen use, and FBDs in adults. Materials and Methods: In this cross-sectional study, 812 adult participants attending a tertiary gastroenterology outpatient clinic were evaluated using structured questionnaires. Data on total daily screen time, duration of toilet use, and smartphone use during toilet time were collected. FBDs were diagnosed according to Rome IV criteria. Associations were analyzed using univariate and multivariate logistic regression models. Results: FBDs were identified in 29% of participants. Total daily screen time was not significantly associated with FBDs (p = 0.094). In contrast, a strong dose–response relationship was observed between toilet-related smartphone use and FBD prevalence, reaching 75.9% among individuals using smartphones for more than 45 minutes during toilet time (p < 0.001). In multivariate analysis, toilet duration remained an independent predictor of FBDs (OR: 1.714, 95% CI: 1.426–2.059, p < 0.001). Conclusion: Toilet-related smartphone use, rather than total screen exposure, is significantly associated with functional bowel disorders. These findings suggest that the behavioral context of screen use may influence bowel function through gut–brain axis mechanisms. Assessment of toilet-related screen habits may represent a simple and modifiable target in clinical practice. Clinical trial registration Not applicable. Functional bowel disorders screen time toilet behavior gut–brain axis sedentary lifestyle INTRODUCTION Gastrointestinal symptoms such as abdominal pain, bloating, and constipation are highly prevalent in the general population; however, an identifiable organic cause cannot be demonstrated in a substantial proportion of affected individuals. These patients are commonly classified within the spectrum of functional gastrointestinal disorders (FBDs) and are diagnosed with conditions including irritable bowel syndrome (IBS), functional constipation (FC), functional diarrhea (FD) and functional bloating (FB). FBDs affect approximately one quarter of the population at some point in life and are characterized by a chronic, relapsing, and fluctuating clinical course [ 1 ]. The pathophysiology of FBDs is multifactorial and incompletely understood, involving the complex interplay of several biological and psychosocial mechanisms. Key contributors include bidirectional dysregulation of the gut–brain axis, alterations in gut microbiota composition, changes in mucosal immune function, disturbances in gastrointestinal motility, and enhanced visceral sensitivity [ 2 ]. Behavioral and psychosocial factors further modulate these mechanisms and play a pivotal role in both symptom generation and persistence. In recent years, screen-based behaviors have become an integral component of modern sedentary lifestyles. Prolonged screen exposure has been associated with disruption of circadian rhythms and sleep patterns, which may, in turn, adversely affect gastrointestinal motility. Furthermore, excessive screen use may increase stress hormone levels, particularly cortisol, and exacerbate visceral hypersensitivity. When combined with physical inactivity, these factors may contribute to prolonged intestinal transit time, impaired defecation patterns, and increased abdominal pain [ 3 – 5 ]. Accordingly, increased screen time may indirectly influence both the frequency and severity of symptoms in patients with functional gastrointestinal disorders. MATERIALS and METHODS Study Design and Participants This study was designed as a cross-sectional, observational investigation conducted in adult patients attending the Gastroenterology Outpatient Clinic of Gazi University Faculty of Medicine. Consecutive voluntary participants aged 18–80 years who presented to the outpatient clinic between June 27 and October 1, 2025 were included in the study. Data were collected using structured questionnaires administered to eligible participants. Variables and Measurements Daily total screen time (hours/day): Self-reported by participants and recorded as the total duration of smartphone, tablet, computer, and television use. Time spent in the toilet: Categorized based on participant self-report as 0–15 minutes, 15–30 minutes, 30–45 minutes, and more than 45 minutes. Screen use during toilet time (minutes/day): Classified using the same categories (0–15, 15–30, 30–45, and > 45 minutes). Functional bowel disorders: The presence of irritable bowel syndrome (IBS), functional constipation, functional diarrhea, and functional bloating/distension was assessed according to the Rome IV criteria. Demographic and clinical data: Age, sex, height, weight, comorbid conditions, and medication use were recorded. Exclusion Criteria Participants were excluded from the study if they met any of the following criteria: Presence of alarm symptoms, including unintentional weight loss, iron deficiency anemia, gastrointestinal bleeding (melena or hematochezia), nocturnal abdominal pain, or newly developed changes in bowel habits accompanied by a family history of colorectal cancer. Known organic gastrointestinal diseases, including inflammatory bowel disease, celiac disease, colorectal malignancy, peptic ulcer disease, short bowel syndrome, or severe malabsorption. History of major colorectal surgery. Endocrine, metabolic, or systemic diseases that could cause secondary constipation or diarrhea (e.g., diabetic neuropathy, hypothyroidism, renal or hepatic failure). Use of laxatives, opioids, anticholinergic agents, colchicine, magnesium-containing antacids, or broad-spectrum antibiotics within the preceding four weeks. Pregnancy or age below 18 years or above 80 years. Incomplete or inconsistent questionnaire responses. Data Collection Data were collected during outpatient visits under the supervision of trained research personnel using standardized paper-based or electronic questionnaire forms. All questions were formulated to assess participants’ typical status over the preceding four weeks. Individuals meeting the Rome IV criteria for irritable bowel syndrome, functional constipation, functional diarrhea, or functional bloating were classified as having a functional bowel disorder (FBD), and participants were accordingly divided into two groups: with and without FBD. Ethical Approval The study was conducted in accordance with the approval of the Gazi University Clinical Research Ethics Committee (approval number 2025-1011), reviewed at the meeting held on May 27, 2025 (session no. 09). Written informed consent was obtained from all participants, and all data were stored anonymously. Statistical Analysis Statistical analyses were performed using IBM SPSS Statistics version 31.0. Descriptive statistics were presented as mean ± standard deviation (SD) or median (minimum–maximum) for continuous variables, and as numbers and percentages for categorical variables. The distribution of continuous variables was assessed using the Kolmogorov–Smirnov test. Between-group comparisons were performed using the independent samples t -test for normally distributed variables and the Mann–Whitney U test for non-normally distributed variables. Associations between categorical variables were evaluated using the chi-square (χ²) test or Fisher’s exact test, as appropriate. Screen time was analyzed both as a continuous variable (hours/day) and in categorized form for toilet-related duration. To identify independent factors associated with irritable bowel syndrome and other functional bowel disorders, univariate analyses were first performed, followed by multivariate logistic regression analysis including variables with p < 0.10 in univariate testing. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). A two-sided p value < 0.05 was considered statistically significant. Results A total of 812 participants were included in the study. According to the Rome IV criteria, 236 participants (29%) were diagnosed with a functional bowel disorder (FBD), while 576 participants (71%) had no evidence of a functional bowel disorder. When demographic characteristics were compared between participants with and without FBD, no significant difference was observed in age distribution (33.61 ± 11.30 vs. 34.62 ± 12.11 years; p = 0.275). A significant difference was observed in sex distribution; the proportion of women was significantly higher in the FBD group compared with the non-FBD group (72.8% vs. 63.1%; p = 0.008). Mean body mass index (BMI) values were similar between the two groups, with no statistically significant difference (25.1 ± 4.7 vs. 25.1 ± 8.0 kg/m²; p = 0.980). With respect to smoking status, the prevalence of active smoking was 66.9% in the FBD group and 72.5% in the non-FBD group, with no significant difference between groups ( p = 0.248). The proportions of non-smokers and former smokers were also comparable between the groups. Alcohol consumption was reported by 28% of participants with FBD and 31.8% of those without FBD, with no statistically significant difference ( p = 0.320). Educational level was generally similar between groups across primary school, high school, university, and postgraduate education categories. Although the proportion of high school graduates appeared slightly higher in the FBD group, this difference did not reach statistical significance ( p = 0.068). ( Table 1) Table 1: Demographic Characteristics of Participants Variable FBD (+) FBD (-) p Age (mean±SD) 33.61±11.30 34.62±12.11 0.275 Female, n (%) 172 (72.8%) 364 (63.1%) 0.008 Male, n (%) 64 (27.2%) 212 (36.8%) BMI (kg/m²) 25.1±4.7 25.1±8.0 0.980 Smoking - Active, n (%) 158 (66.9%) 418 (72.5%) 0.248 Smoking – Non-user, n (%) 66 (28%) 134 (23.3%) Smoking- Ex-smoker, n (%) 12 (5.1%) 24 (4.2%) Alcohol- absent n (%) 170 (72%) 393 (68.2%) 0.320 Alcohol- present n (%) 66 (28%) 183 (31.8%) Primary school, n (%) 11 (4.6%) 15 (2.6%) 0.068 Highvschool n (%) 58 (24.6%) 103 (17.9%) University, n (%) 121 (51.3%) 314 (54.5%) Post-graduate, n (%) 46 (19.5%) 144 (25%) Total daily screen time (hours/day) 6.28±2.7 5.92±2.7 0.094 FBD: Functional Bowel Disorders SD: Standart Deviation The mean total daily screen time was 6.28 ± 2.7 hours/day in the FBD group and 5.92 ± 2.7 hours/day in the non-FBD group, with no statistically significant difference between groups ( p = 0.094). Daily phone usage duration did not differ significantly between participants with and without FBD ( p = 0.088). However, a gradual increase in the prevalence of FBD was observed with increasing phone usage duration. The prevalence of FBD was 22.4% among participants using their phone for less than 1 hour per day, 24.9% in those using their phone for 1–3 hours, 29.8% in those using their phone for 3–5 hours, and 35.1% in those using their phone for more than 5 hours per day. Although this trend did not reach statistical significance, it suggested a linear increase in FBD prevalence with longer phone usage duration. No significant association was found between computer usage duration and FBD ( p = 0.575). The prevalence of FBD was 30.9% among participants using a computer for less than 1 hour per day, 26.1% among those using a computer for 1–3 hours, 31.1% in the 3–5 hour group, and 27.6% among those using a computer for more than 5 hours per day. These findings indicate a fluctuating distribution without a clear linear trend. Similarly, no significant association was observed between television viewing duration and FBD ( p = 0.087). The prevalence of FBD was 27.8% among participants watching television for less than 1 hour per day, 30.5% in the 1–3 hour group, and reached its highest level (42.9%) among those watching television for 3–5 hours per day. In contrast, the prevalence decreased to 14.3% among participants watching television for more than 5 hours per day, indicating the absence of a consistent linear pattern. The duration of time spent in the toilet differed significantly between participants with and without FBD ( p <0.001). The prevalence of FBD increased progressively with longer toilet duration. FBD was present in 21.8% of participants who spent less than 15 minutes in the toilet, 27.5% of those spending 15–30 minutes, 38.5% of those spending 30–45 minutes, and 66.6% of those spending more than 45 minutes in the toilet. ( Table 2) Phone use during toilet time was also significantly associated with FBD ( p <0.001). The prevalence of FBD increased markedly with longer phone use during toilet time, being 23.3% among participants using their phone for less than 15 minutes, 38.6% among those using it for 15–30 minutes, 41.9% among those using it for 30–45 minutes, and 75.9% among those using it for more than 45 minutes. ( Table 3 ) Table 2. Time spent in the toilet Time FBD + n (%) FBD - n (%) Total n p <15 min 66 (21.8%) 237 (78.2%) 303 45 min 28 (66.6%) 14 (33.4%) 42 FBD: Functional Bowel Disorders Table 3 Time spent using the phone in the toilet Time FBD + n (%) FBD -(%) Total n p <15 min 137 (23.3%) 450 (76.5%) 587 45 min 22 (75.9%) 7 (24.1%) 29 FBD: Functional Bowel Disorders Univariate logistic regression analysis demonstrated a significant association between toilet-related phone use duration and functional bowel disorders (FBDs). Compared with participants who used their phones for less than 15 minutes during toilet time (reference group), the odds of FBD increased progressively with longer exposure durations. Phone use of 15–30 minutes was associated with approximately a twofold increase in FBD risk, while usage exceeding 45 minutes showed a markedly elevated risk, indicating a clear dose–response relationship. ( Table 4) Table 4: Univariate logistic regression Toilet phone use duration OR (Exp(B)) 95% CI p value <15 min (reference) 1.00 — — 15–30 min 2.012 1.378–2.939 45 min 10.248 4.287–24.502 <0.001 OR: Odds ratio , CI: Confidence Interval In multivariable logistic regression analysis adjusted for age, sex, body mass index (BMI), smoking status, and alcohol consumption, toilet duration remained an independent predictor of functional bowel disorders (FBDs). Each increase in toilet duration category was associated with a 71% increase in the odds of FBD (OR: 1.714, 95% CI: 1.426–2.059, p <0.001). Female sex was also independently associated with FBD (OR: 0.616, 95% CI: 0.436–0.871, p = 0.006), whereas age, BMI, smoking, and alcohol consumption were not significantly associated with the outcome. The overall model was statistically significant (χ² = 45.214, p < 0.001) with a Nagelkerke R² of 0.077 and an overall classification accuracy of 72.7%.This graded increase supports a potential behavioral dose–response association between toilet-related screen exposure and FBD. ( Table 5) Table 5 Multivariate logistic regression Variable B OR (Exp(B)) 95% CI p value Age -0.001 0.999 0.985–1.013 0.836 Female sex -0.484 0.616 0.436–0.871 0.006 BMI -0.001 0.999 0.979–1.020 0.949 Smoking -0.188 0.828 0.598–1.147 0.257 Alcohol use 0.202 1.224 0.855–1.752 0.270 Toilet duration (per category increase) 0.539 1.714 1.426–2.059 <0.001 OR: Odds ratio, BMI: Body Mass Index , CI: Confidence Interval When participants with FBD were evaluated according to disease subtypes, the most common subtype was functional bloating, accounting for 41.5% of cases (n = 98). This was followed by functional constipation (28.4%, n = 67), functional diarrhea (15.3%, n = 36), and functional abdominal pain (14.8%, n = 35). This distribution indicates that bloating and constipation were the predominant symptom patterns within the FBD group. Comparison of functional bowel disorder subtypes according to total daily screen time revealed no significant differences between groups ( p = 0.522). The mean daily screen time was 6.0 ± 2.4 hours in participants with FBD, 6.0 ± 2.8 hours in those with functional bloating, 6.6 ± 3.2 hours in those with functional diarrhea, and 6.5 ± 2.3 hours in those with functional constipation. These findings suggest that total daily screen time was similar across functional bowel disorder subtypes. DISCUSSION In this study, screen-based behaviors and toilet-related habits were comprehensively evaluated in individuals with functional bowel disorders (FBDs). In recent years, sedentary lifestyle has been identified as one of the leading risk factors for non-communicable diseases. Large cohort studies have demonstrated associations between screen-based sedentary behaviors—such as prolonged sitting time and television viewing—and increased risks of mortality, cardiovascular disease, and colorectal cancer. A similar trend has been reported for functional gastrointestinal disorders, with sedentary lifestyle potentially increasing the risk of irritable bowel syndrome (IBS) [6].However, the available evidence remains inconsistent. Mendelian randomization analyses suggest that prolonged sitting time may increase the risk of IBS independently of obesity [7]. In the present study, no direct association was observed between total screen time and FBD; however, toilet-related screen behaviors were found to be strongly associated with FBD. This finding suggests that the impact of sedentary behavior may depend not only on its duration but also on the context in which it occurs. A survey conducted in Israel involving 500 adults reported that reading or using a phone in the toilet was present in 52.7% of the population. This habit was more common among men, younger individuals, secular participants, those with higher educational levels, and office workers. Individuals who read in the toilet were found to spend significantly longer time in the toilet; however, no statistically significant differences were observed in stool consistency, defecation frequency, constipation, or hemorrhoid prevalence (constipation: 8% vs. 13.7%; hemorrhoids: 23.6% vs. 18.2; p > 0.05). The authors emphasized that this behavior was primarily driven by leisure rather than medical necessity, although it prolonged toilet duration [8]. These findings are consistent with our results, highlighting that toilet-related behaviors—rather than total screen time—may be more relevant to functional bowel symptoms. Our findings demonstrate that individuals with FBD differed markedly with respect to both time spent in the toilet and phone use during toilet time. The progressive increase in FBD prevalence with longer toilet duration, reaching 66.6% among participants spending more than 45 minutes in the toilet, supports an association between defecation dynamics, pelvic floor function, and behavioral habits in FBD. Similarly, a strong and consistent increasing trend was observed for phone use during toilet time, with FBD prevalence rising to 75.9% among individuals using their phone for more than 45 minutes. These findings suggest that toilet-related behaviors may represent not only a consequence of symptoms but also a potentially important behavioral factor contributing to the development or persistence of FBD symptoms. The gut–brain axis refers to the bidirectional communication network between the gastrointestinal tract and the central nervous system, in which stress, attention, sensory perception, autonomic nervous system activity, and behavioral habits play integral roles. Prolonged toilet sitting is often associated with stool withholding, distraction, cognitive engagement, and stress reduction behaviors, which may suppress the defecation reflex and adversely affect pelvic floor function[9, 10]. The markedly increased frequency of toilet sessions exceeding 45 minutes among individuals with FBD in our study supports the hypothesis that such behaviors may influence intestinal motility and visceral sensitivity through modulation of the gut–brain axis. Similarly, increased phone use during toilet time may promote continuous cognitive engagement with digital stimuli, triggering sympathetic activation. Enhanced sympathetic tone combined with reduced parasympathetic activity may slow colonic motility, increase visceral hypersensitivity, and thereby contribute to the persistence of FBD symptoms. The observation that FBD prevalence reached 75.9% among individuals using their phone for more than 45 minutes in the toilet represents a notable finding in terms of behavioral modulation of the gut–brain axis. The absence of significant differences in total daily screen time across FBD subtypes suggests that screen exposure may reflect a behavioral and neurophysiological vulnerability at the axis level rather than being specific to a particular disease subtype. The higher prevalence of functional bloating and constipation observed in our cohort is also consistent with the known effects of the gut–brain axis on gastrointestinal motility and sensory processing. Overall, this study demonstrates that toilet-related screen behaviors represent not merely lifestyle habits but potentially important behavioral factors influencing bowel function through the gut–brain axis. Routine assessment of these behaviors in clinical practice, along with targeted behavioral interventions when appropriate, may offer a novel and practical approach to the management of functional bowel disorders. LIMITATIONS This study has several limitations that should be acknowledged. First, its cross-sectional design precludes any causal inference between screen-based or toilet-related behaviors and functional bowel disorders. Second, all behavioral variables, including screen time and toilet habits, were assessed using self-reported questionnaires, which may be subject to recall bias and social desirability bias. Third, although a relatively large sample size was included, the study was conducted at a single tertiary care center, which may limit the generalizability of the findings to other populations. In addition, psychological variables such as stress levels, anxiety severity, and sleep quality were not assessed using validated scales, and their potential confounding effects could not be fully evaluated. Finally, objective measurements of screen exposure and toilet duration were not available. Despite these limitations, the study provides clinically relevant insights into the association between toilet-related screen behaviors and functional bowel disorders. CONCLUSION In conclusion, this study demonstrates that toilet-related smartphone use, rather than total daily screen time, is significantly associated with functional bowel disorders in adults. A clear dose–response relationship was observed between prolonged toilet duration, extended smartphone use during defecation, and increasing prevalence of FBDs. These findings highlight that the context of sedentary behavior may be more relevant than its total duration. Toilet-related screen use may represent a modifiable behavioral factor influencing bowel function, potentially through alterations in defecatory dynamics and gut–brain axis regulation. Although causality cannot be established due to the cross-sectional design, incorporating simple questions regarding toilet-related smartphone habits into routine clinical assessment may provide a practical and clinically relevant intervention target. Future prospective and mechanistic studies are warranted. Declarations Ethics Approval and Consent to Participate This study was conducted in accordance with the Declaration of Helsinki and was approved by the Gazi University Clinical Research Ethics Committee (approval number: 2025-1011, date: May 27, 2025). Written informed consent was obtained from all participants prior to inclusion in the study. Consent for Publication Not applicable. Competing Interests The authors declare that they have no competing interests. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Clinical trial registration Not applicable. Data Availability Statement The datasets generated and/or analysed during the current study are not publicly available due to patient confidentiality and institutional ethical restrictions. All data were collected as part of routine clinical care and are subject to local data protection regulations. However, anonymized data supporting the findings of this study are available from the corresponding author upon reasonable request. References Arif TB, et al. Global prevalence and risk factors of irritable bowel syndrome from 2006 to 2024 using the Rome III and IV criteria: a meta-analysis. European Journal of Gastroenterology & Hepatology; 2025. p. 101097. Black CJ, et al. Functional gastrointestinal disorders: advances in understanding and management. Lancet. 2020;396(10263):1664–74. Duboc H, Coffin B, Siproudhis L. Disruption of Circadian Rhythms and Gut Motility: An Overview of Underlying Mechanisms and Associated Pathologies. J Clin Gastroenterol. 2020;54(5):405–14. Codoñer-Franch P, Gombert M. Circadian rhythms in the pathogenesis of gastrointestinal diseases. World J Gastroenterol. 2018;24(38):4297–303. Mayer EA. Gut feelings: the emerging biology of gut–brain communication. Nat Rev Neurosci. 2011;12(8):453–66. Johannesson E, et al. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Official J Am Coll Gastroenterology| ACG. 2011;106(5):915–22. Lu L, et al. The causal effects of leisure screen time on irritable bowel syndrome risk from a Mendelian randomization study. Sci Rep. 2023;13(1):13216. Goldstein O, et al. Toilet reading habits in Israeli adults. Neurogastroenterology Motil. 2009;21(3):291–5. Moloney RD, et al. Stress and the microbiota–gut–brain axis in visceral pain: relevance to irritable bowel syndrome. Volume 22. CNS neuroscience & therapeutics; 2016. pp. 102–17. 2. Kaygısız N, et al. Evaluation of Toilet Habits and Self-Awareness of Constipation Statuses Among Young Adults From Different Faculties At Acibadem University. Turkish Med Student J. 2021;8(1):22–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 27 Apr, 2026 Editor assigned by journal 20 Apr, 2026 Submission checks completed at journal 18 Apr, 2026 First submitted to journal 18 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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University","correspondingAuthor":false,"prefix":"","firstName":"Murat","middleName":"","lastName":"Kekilli","suffix":""},{"id":634068759,"identity":"f8ba8fe8-a7d6-4017-92d8-71c9a4aee342","order_by":14,"name":"Tarkan Karakan","email":"","orcid":"","institution":"Gazi University","correspondingAuthor":false,"prefix":"","firstName":"Tarkan","middleName":"","lastName":"Karakan","suffix":""},{"id":634068762,"identity":"5b1d9038-ec38-4f2a-8e39-840078b199fa","order_by":15,"name":"Mehmet Cindoruk","email":"","orcid":"","institution":"Gazi University","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"Cindoruk","suffix":""}],"badges":[],"createdAt":"2026-03-31 11:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9279150/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9279150/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108805453,"identity":"3b83c1ff-da83-44bc-8b69-b9042951d323","added_by":"auto","created_at":"2026-05-08 15:26:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":277179,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9279150/v1/b5d55118-c49a-42fd-9251-bdedf83272c6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Beyond Total Screen Time: The Strong Association Between Toilet-Related Smartphone Use and Functional Bowel Disorders","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eGastrointestinal symptoms such as abdominal pain, bloating, and constipation are highly prevalent in the general population; however, an identifiable organic cause cannot be demonstrated in a substantial proportion of affected individuals. These patients are commonly classified within the spectrum of functional gastrointestinal disorders (FBDs) and are diagnosed with conditions including irritable bowel syndrome (IBS), functional constipation (FC), functional diarrhea (FD) and functional bloating (FB). FBDs affect approximately one quarter of the population at some point in life and are characterized by a chronic, relapsing, and fluctuating clinical course [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe pathophysiology of FBDs is multifactorial and incompletely understood, involving the complex interplay of several biological and psychosocial mechanisms. Key contributors include bidirectional dysregulation of the gut\u0026ndash;brain axis, alterations in gut microbiota composition, changes in mucosal immune function, disturbances in gastrointestinal motility, and enhanced visceral sensitivity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Behavioral and psychosocial factors further modulate these mechanisms and play a pivotal role in both symptom generation and persistence.\u003c/p\u003e \u003cp\u003eIn recent years, screen-based behaviors have become an integral component of modern sedentary lifestyles. Prolonged screen exposure has been associated with disruption of circadian rhythms and sleep patterns, which may, in turn, adversely affect gastrointestinal motility. Furthermore, excessive screen use may increase stress hormone levels, particularly cortisol, and exacerbate visceral hypersensitivity. When combined with physical inactivity, these factors may contribute to prolonged intestinal transit time, impaired defecation patterns, and increased abdominal pain [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Accordingly, increased screen time may indirectly influence both the frequency and severity of symptoms in patients with functional gastrointestinal disorders.\u003c/p\u003e"},{"header":"MATERIALS and METHODS","content":"\u003cp\u003eStudy Design and Participants\u003c/p\u003e \u003cp\u003eThis study was designed as a cross-sectional, observational investigation conducted in adult patients attending the Gastroenterology Outpatient Clinic of Gazi University Faculty of Medicine. Consecutive voluntary participants aged 18\u0026ndash;80 years who presented to the outpatient clinic between June 27 and October 1, 2025 were included in the study. Data were collected using structured questionnaires administered to eligible participants.\u003c/p\u003e \u003cp\u003eVariables and Measurements\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eDaily total screen time (hours/day): Self-reported by participants and recorded as the total duration of smartphone, tablet, computer, and television use.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTime spent in the toilet: Categorized based on participant self-report as 0\u0026ndash;15 minutes, 15\u0026ndash;30 minutes, 30\u0026ndash;45 minutes, and more than 45 minutes.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eScreen use during toilet time (minutes/day): Classified using the same categories (0\u0026ndash;15, 15\u0026ndash;30, 30\u0026ndash;45, and \u0026gt;\u0026thinsp;45 minutes).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFunctional bowel disorders: The presence of irritable bowel syndrome (IBS), functional constipation, functional diarrhea, and functional bloating/distension was assessed according to the Rome IV criteria.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDemographic and clinical data: Age, sex, height, weight, comorbid conditions, and medication use were recorded.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eExclusion Criteria\u003c/p\u003e \u003cp\u003eParticipants were excluded from the study if they met any of the following criteria:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePresence of alarm symptoms, including unintentional weight loss, iron deficiency anemia, gastrointestinal bleeding (melena or hematochezia), nocturnal abdominal pain, or newly developed changes in bowel habits accompanied by a family history of colorectal cancer.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eKnown organic gastrointestinal diseases, including inflammatory bowel disease, celiac disease, colorectal malignancy, peptic ulcer disease, short bowel syndrome, or severe malabsorption.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHistory of major colorectal surgery.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEndocrine, metabolic, or systemic diseases that could cause secondary constipation or diarrhea (e.g., diabetic neuropathy, hypothyroidism, renal or hepatic failure).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUse of laxatives, opioids, anticholinergic agents, colchicine, magnesium-containing antacids, or broad-spectrum antibiotics within the preceding four weeks.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePregnancy or age below 18 years or above 80 years.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIncomplete or inconsistent questionnaire responses.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eData Collection\u003c/p\u003e \u003cp\u003eData were collected during outpatient visits under the supervision of trained research personnel using standardized paper-based or electronic questionnaire forms. All questions were formulated to assess participants\u0026rsquo; typical status over the preceding four weeks. Individuals meeting the Rome IV criteria for irritable bowel syndrome, functional constipation, functional diarrhea, or functional bloating were classified as having a functional bowel disorder (FBD), and participants were accordingly divided into two groups: with and without FBD.\u003c/p\u003e\u003cp\u003eEthical Approval\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the approval of the Gazi University Clinical Research Ethics Committee (approval number\u0026nbsp;2025-1011), reviewed at the meeting held on\u0026nbsp;May 27, 2025\u0026nbsp;(session no. 09). Written informed consent was obtained from all participants, and all data were stored anonymously.\u003c/p\u003e\n\u003cp\u003eStatistical Analysis\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics version 31.0. Descriptive statistics were presented as mean \u0026plusmn; standard deviation (SD) or median (minimum\u0026ndash;maximum) for continuous variables, and as numbers and percentages for categorical variables. The distribution of continuous variables was assessed using the Kolmogorov\u0026ndash;Smirnov test. Between-group comparisons were performed using the independent samples \u003cem\u003et\u003c/em\u003e-test for normally distributed variables and the Mann\u0026ndash;Whitney \u003cem\u003eU\u003c/em\u003e test for non-normally distributed variables. Associations between categorical variables were evaluated using the chi-square (\u0026chi;\u0026sup2;) test or Fisher\u0026rsquo;s exact test, as appropriate.\u003c/p\u003e\n\u003cp\u003eScreen time was analyzed both as a continuous variable (hours/day) and in categorized form for toilet-related duration. To identify independent factors associated with irritable bowel syndrome and other functional bowel disorders, univariate analyses were first performed, followed by multivariate logistic regression analysis including variables with \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.10 in univariate testing. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). A two-sided \u003cem\u003ep\u003c/em\u003e value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of\u0026nbsp;812 participants\u0026nbsp;were included in the study. According to the Rome IV criteria,\u0026nbsp;236 participants (29%)\u0026nbsp;were diagnosed with a functional bowel disorder (FBD), while\u0026nbsp;576 participants (71%)\u0026nbsp;had no evidence of a functional bowel disorder.\u003c/p\u003e\n\u003cp\u003eWhen demographic characteristics were compared between participants with and without FBD, no significant difference was observed in age distribution (33.61 \u0026plusmn; 11.30 vs. 34.62 \u0026plusmn; 12.11 years; \u003cem\u003ep\u003c/em\u003e = 0.275). A significant difference was observed in sex distribution; the proportion of women was significantly higher in the FBD group compared with the non-FBD group (72.8% vs. 63.1%; \u003cem\u003ep\u003c/em\u003e = 0.008).\u003c/p\u003e\n\u003cp\u003eMean body mass index (BMI) values were similar between the two groups, with no statistically significant difference (25.1 \u0026plusmn; 4.7 vs. 25.1 \u0026plusmn; 8.0 kg/m\u0026sup2;; \u003cem\u003ep\u003c/em\u003e = 0.980).\u003c/p\u003e\n\u003cp\u003eWith respect to smoking status, the prevalence of active smoking was 66.9% in the FBD group and 72.5% in the non-FBD group, with no significant difference between groups (\u003cem\u003ep\u003c/em\u003e = 0.248). The proportions of non-smokers and former smokers were also comparable between the groups.\u003c/p\u003e\n\u003cp\u003eAlcohol consumption was reported by 28% of participants with FBD and 31.8% of those without FBD, with no statistically significant difference (\u003cem\u003ep\u003c/em\u003e = 0.320).\u003c/p\u003e\n\u003cp\u003eEducational level was generally similar between groups across primary school, high school, university, and postgraduate education categories. Although the proportion of high school graduates appeared slightly higher in the FBD group, this difference did not reach statistical significance (\u003cem\u003ep\u003c/em\u003e = 0.068). ( Table 1)\u003c/p\u003e\n\u003cp\u003eTable 1: \u0026nbsp;Demographic Characteristics of Participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eFBD (+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFBD (-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAge \u0026nbsp;(mean\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e33.61\u0026plusmn;11.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e34.62\u0026plusmn;12.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eFemale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e172 (72.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e364 (63.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eMale, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e64 (27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e212 (36.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e25.1\u0026plusmn;4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e25.1\u0026plusmn;8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.980\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSmoking - Active, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e158 (66.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e418 (72.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSmoking \u0026ndash; Non-user, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e66 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e134 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSmoking- Ex-smoker, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e12 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e24 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAlcohol- \u0026nbsp;absent n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e170 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e393 (68.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAlcohol- present n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e66 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e183 (31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003ePrimary school, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e11 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e15 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eHighvschool n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e58 (24.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e103 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eUniversity, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e121 (51.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e314 (54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003ePost-graduate, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e46 (19.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e144 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTotal daily screen time (hours/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6.28\u0026plusmn;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5.92\u0026plusmn;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 576px;\"\u003e\n \u003cp\u003eFBD: Functional Bowel Disorders \u0026nbsp;SD: Standart Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe mean total daily screen time was 6.28 \u0026plusmn; 2.7 hours/day in the FBD group and 5.92 \u0026plusmn; 2.7 hours/day in the non-FBD group, with no statistically significant difference between groups (\u003cem\u003ep\u003c/em\u003e = 0.094).\u003c/p\u003e\n\u003cp\u003eDaily phone usage duration did not differ significantly between participants with and without FBD (\u003cem\u003ep\u003c/em\u003e = 0.088). However, a gradual increase in the prevalence of FBD was observed with increasing phone usage duration. The prevalence of FBD was 22.4% among participants using their phone for less than 1 hour per day, 24.9% in those using their phone for 1\u0026ndash;3 hours, 29.8% in those using their phone for 3\u0026ndash;5 hours, and 35.1% in those using their phone for more than 5 hours per day. Although this trend did not reach statistical significance, it suggested a linear increase in FBD prevalence with longer phone usage duration.\u003c/p\u003e\n\u003cp\u003eNo significant association was found between computer usage duration and FBD (\u003cem\u003ep\u003c/em\u003e = 0.575). The prevalence of FBD was 30.9% among participants using a computer for less than 1 hour per day, 26.1% among those using a computer for 1\u0026ndash;3 hours, 31.1% in the 3\u0026ndash;5 hour group, and 27.6% among those using a computer for more than 5 hours per day. These findings indicate a fluctuating distribution without a clear linear trend.\u003c/p\u003e\n\u003cp\u003eSimilarly, no significant association was observed between television viewing duration and FBD (\u003cem\u003ep\u003c/em\u003e = 0.087). The prevalence of FBD was 27.8% among participants watching television for less than 1 hour per day, 30.5% in the 1\u0026ndash;3 hour group, and reached its highest level (42.9%) among those watching television for 3\u0026ndash;5 hours per day. In contrast, the prevalence decreased to 14.3% among participants watching television for more than 5 hours per day, indicating the absence of a consistent linear pattern.\u003c/p\u003e\n\u003cp\u003eThe duration of time spent in the toilet differed significantly between participants with and without FBD (\u003cem\u003ep\u003c/em\u003e \u0026lt;0.001). The prevalence of FBD increased progressively with longer toilet duration. FBD was present in 21.8% of participants who spent less than 15 minutes in the toilet, 27.5% of those spending 15\u0026ndash;30 minutes, 38.5% of those spending 30\u0026ndash;45 minutes, and 66.6% of those spending more than 45 minutes in the toilet. ( Table 2)\u003c/p\u003e\n\u003cp\u003ePhone use during toilet time was also significantly associated with FBD (\u003cem\u003ep\u003c/em\u003e \u0026lt;0.001). The prevalence of FBD increased markedly with longer phone use during toilet time, being 23.3% among participants using their phone for less than 15 minutes, 38.6% among those using it for 15\u0026ndash;30 minutes, 41.9% among those using it for 30\u0026ndash;45 minutes, and 75.9% among those using it for more than 45 minutes. ( Table 3 )\u003c/p\u003e\n\u003cp\u003eTable 2. Time spent in the toilet\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eFBD + n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eFBD - n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eTotal n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026lt;15 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e66 (21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e237 (78.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e15\u0026ndash;30 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e95 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e250 (71.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e30\u0026ndash;45 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e47 (38.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e75 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026gt;45 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e28 (66.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e14 (33.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 576px;\"\u003e\n \u003cp\u003eFBD: Functional Bowel Disorders \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 Time spent using the phone in the toilet\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eFBD + n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eFBD -(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eTotal n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026lt;15 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e137 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e450 (76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e15\u0026ndash;30 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e59 (38.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e94 (61.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e30\u0026ndash;45 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e18 (41.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e25 (58.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026gt;45 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e22 (75.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 576px;\"\u003e\n \u003cp\u003eFBD: Functional Bowel Disorders \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eUnivariate logistic regression analysis demonstrated a significant association between toilet-related phone use duration and functional bowel disorders (FBDs). Compared with participants who used their phones for less than 15 minutes during toilet time (reference group), the odds of FBD increased progressively with longer exposure durations. Phone use of 15\u0026ndash;30 minutes was associated with approximately a twofold increase in FBD risk, while usage exceeding 45 minutes showed a markedly elevated risk, indicating a clear dose\u0026ndash;response relationship. ( Table 4)\u003c/p\u003e\n\u003cp\u003eTable 4: Univariate logistic regression\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eToilet phone use duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eOR (Exp(B))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;15 min (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e15\u0026ndash;30 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.378\u0026ndash;2.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e30\u0026ndash;45 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.244\u0026ndash;4.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;45 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10.248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.287\u0026ndash;24.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003eOR: Odds ratio , CI: Confidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn multivariable logistic regression analysis adjusted for age, sex, body mass index (BMI), smoking status, and alcohol consumption, toilet duration remained an independent predictor of functional bowel disorders (FBDs). Each increase in toilet duration category was associated with a 71% increase in the odds of FBD (OR: 1.714, 95% CI: 1.426\u0026ndash;2.059, p \u0026lt;0.001). Female sex was also independently associated with FBD (OR: 0.616, 95% CI: 0.436\u0026ndash;0.871, p = 0.006), whereas age, BMI, smoking, and alcohol consumption were not significantly associated with the outcome. The overall model was statistically significant (\u0026chi;\u0026sup2; = 45.214, p \u0026lt; 0.001) with a Nagelkerke R\u0026sup2; of 0.077 and an overall classification accuracy of 72.7%.This graded increase supports a potential behavioral dose\u0026ndash;response association between toilet-related screen exposure and FBD. ( Table 5)\u003c/p\u003e\n\u003cp\u003eTable 5 Multivariate logistic regression\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eOR (Exp(B))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.985\u0026ndash;1.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eFemale sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e-0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.436\u0026ndash;0.871\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.979\u0026ndash;1.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e-0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.598\u0026ndash;1.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eAlcohol use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.855\u0026ndash;1.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eToilet duration (per category increase)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1.426\u0026ndash;2.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 576px;\"\u003e\n \u003cp\u003eOR: Odds ratio, BMI: Body Mass Index , CI: Confidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWhen participants with FBD were evaluated according to disease subtypes, the most common subtype was functional bloating, accounting for 41.5% of cases (n = 98). This was followed by functional constipation (28.4%, n = 67), functional diarrhea (15.3%, n = 36), and functional abdominal pain (14.8%, n = 35). This distribution indicates that bloating and constipation were the predominant symptom patterns within the FBD group.\u003c/p\u003e\n\u003cp\u003eComparison of functional bowel disorder subtypes according to total daily screen time revealed no significant differences between groups (\u003cem\u003ep\u003c/em\u003e = 0.522). The mean daily screen time was 6.0 \u0026plusmn; 2.4 hours in participants with FBD, 6.0 \u0026plusmn; 2.8 hours in those with functional bloating, 6.6 \u0026plusmn; 3.2 hours in those with functional diarrhea, and 6.5 \u0026plusmn; 2.3 hours in those with functional constipation. These findings suggest that total daily screen time was similar across functional bowel disorder subtypes.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, screen-based behaviors and toilet-related habits were comprehensively evaluated in individuals with functional bowel disorders (FBDs). In recent years, sedentary lifestyle has been identified as one of the leading risk factors for non-communicable diseases. Large cohort studies have demonstrated associations between screen-based sedentary behaviors—such as prolonged sitting time and television viewing—and increased risks of mortality, cardiovascular disease, and colorectal cancer. A similar trend has been reported for functional gastrointestinal disorders, with sedentary lifestyle potentially increasing the risk of irritable bowel syndrome (IBS) [6].However, the available evidence remains inconsistent. Mendelian randomization analyses suggest that prolonged sitting time may increase the risk of IBS independently of obesity [7]. In the present study, no direct association was observed between total screen time and FBD; however, toilet-related screen behaviors were found to be strongly associated with FBD. This finding suggests that the impact of sedentary behavior may depend not only on its duration but also on the context in which it occurs.\u003c/p\u003e\n\u003cp\u003eA survey conducted in Israel involving 500 adults reported that reading or using a phone in the toilet was present in 52.7% of the population. This habit was more common among men, younger individuals, secular participants, those with higher educational levels, and office workers. Individuals who read in the toilet were found to spend significantly longer time in the toilet; however, no statistically significant differences were observed in stool consistency, defecation frequency, constipation, or hemorrhoid prevalence (constipation: 8% vs. 13.7%; hemorrhoids: 23.6% vs. 18.2; \u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05). The authors emphasized that this behavior was primarily driven by leisure rather than medical necessity, although it prolonged toilet duration [8]. These findings are consistent with our results, highlighting that toilet-related behaviors—rather than total screen time—may be more relevant to functional bowel symptoms.\u003c/p\u003e\n\u003cp\u003eOur findings demonstrate that individuals with FBD differed markedly with respect to both time spent in the toilet and phone use during toilet time. The progressive increase in FBD prevalence with longer toilet duration, reaching 66.6% among participants spending more than 45 minutes in the toilet, supports an association between defecation dynamics, pelvic floor function, and behavioral habits in FBD. Similarly, a strong and consistent increasing trend was observed for phone use during toilet time, with FBD prevalence rising to 75.9% among individuals using their phone for more than 45 minutes. These findings suggest that toilet-related behaviors may represent not only a consequence of symptoms but also a potentially important behavioral factor contributing to the development or persistence of FBD symptoms.\u003c/p\u003e\n\u003cp\u003eThe gut–brain axis refers to the bidirectional communication network between the gastrointestinal tract and the central nervous system, in which stress, attention, sensory perception, autonomic nervous system activity, and behavioral habits play integral roles. Prolonged toilet sitting is often associated with stool withholding, distraction, cognitive engagement, and stress reduction behaviors, which may suppress the defecation reflex and adversely affect pelvic floor function[9, 10]. The markedly increased frequency of toilet sessions exceeding 45 minutes among individuals with FBD in our study supports the hypothesis that such behaviors may influence intestinal motility and visceral sensitivity through modulation of the gut–brain axis.\u003c/p\u003e\n\u003cp\u003eSimilarly, increased phone use during toilet time may promote continuous cognitive engagement with digital stimuli, triggering sympathetic activation. Enhanced sympathetic tone combined with reduced parasympathetic activity may slow colonic motility, increase visceral hypersensitivity, and thereby contribute to the persistence of FBD symptoms. The observation that FBD prevalence reached 75.9% among individuals using their phone for more than 45 minutes in the toilet represents a notable finding in terms of behavioral modulation of the gut–brain axis.\u003c/p\u003e\n\u003cp\u003eThe absence of significant differences in total daily screen time across FBD subtypes suggests that screen exposure may reflect a behavioral and neurophysiological vulnerability at the axis level rather than being specific to a particular disease subtype. The higher prevalence of functional bloating and constipation observed in our cohort is also consistent with the known effects of the gut–brain axis on gastrointestinal motility and sensory processing.\u003c/p\u003e\n\u003cp\u003eOverall, this study demonstrates that toilet-related screen behaviors represent not merely lifestyle habits but potentially important behavioral factors influencing bowel function through the gut–brain axis. Routine assessment of these behaviors in clinical practice, along with targeted behavioral interventions when appropriate, may offer a novel and practical approach to the management of functional bowel disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLIMITATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations that should be acknowledged. First, its cross-sectional design precludes any causal inference between screen-based or toilet-related behaviors and functional bowel disorders. Second, all behavioral variables, including screen time and toilet habits, were assessed using self-reported questionnaires, which may be subject to recall bias and social desirability bias. Third, although a relatively large sample size was included, the study was conducted at a single tertiary care center, which may limit the generalizability of the findings to other populations. In addition, psychological variables such as stress levels, anxiety severity, and sleep quality were not assessed using validated scales, and their potential confounding effects could not be fully evaluated. Finally, objective measurements of screen exposure and toilet duration were not available. Despite these limitations, the study provides clinically relevant insights into the association between toilet-related screen behaviors and functional bowel disorders.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, this study demonstrates that toilet-related smartphone use, rather than total daily screen time, is significantly associated with functional bowel disorders in adults. A clear dose–response relationship was observed between prolonged toilet duration, extended smartphone use during defecation, and increasing prevalence of FBDs.\u003c/p\u003e\n\u003cp\u003eThese findings highlight that the context of sedentary behavior may be more relevant than its total duration. Toilet-related screen use may represent a modifiable behavioral factor influencing bowel function, potentially through alterations in defecatory dynamics and gut–brain axis regulation.\u003c/p\u003e\n\u003cp\u003eAlthough causality cannot be established due to the cross-sectional design, incorporating simple questions regarding toilet-related smartphone habits into routine clinical assessment may provide a practical and clinically relevant intervention target. Future prospective and mechanistic studies are warranted.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the Gazi University Clinical Research Ethics Committee (approval number: 2025-1011, date: May 27, 2025). Written informed consent was obtained from all participants prior to inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to patient confidentiality and institutional ethical restrictions. All data were collected as part of routine clinical care and are subject to local data protection regulations. However, anonymized data supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArif TB, et al. Global prevalence and risk factors of irritable bowel syndrome from 2006 to 2024 using the Rome III and IV criteria: a meta-analysis. European Journal of Gastroenterology \u0026amp; Hepatology; 2025. p. 101097.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlack CJ, et al. Functional gastrointestinal disorders: advances in understanding and management. Lancet. 2020;396(10263):1664\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuboc H, Coffin B, Siproudhis L. Disruption of Circadian Rhythms and Gut Motility: An Overview of Underlying Mechanisms and Associated Pathologies. J Clin Gastroenterol. 2020;54(5):405\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCodo\u0026ntilde;er-Franch P, Gombert M. Circadian rhythms in the pathogenesis of gastrointestinal diseases. World J Gastroenterol. 2018;24(38):4297\u0026ndash;303.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMayer EA. Gut feelings: the emerging biology of gut\u0026ndash;brain communication. Nat Rev Neurosci. 2011;12(8):453\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohannesson E, et al. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Official J Am Coll Gastroenterology| ACG. 2011;106(5):915\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu L, et al. The causal effects of leisure screen time on irritable bowel syndrome risk from a Mendelian randomization study. Sci Rep. 2023;13(1):13216.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldstein O, et al. Toilet reading habits in Israeli adults. Neurogastroenterology Motil. 2009;21(3):291\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoloney RD, et al. Stress and the microbiota\u0026ndash;gut\u0026ndash;brain axis in visceral pain: relevance to irritable bowel syndrome. Volume 22. CNS neuroscience \u0026amp; therapeutics; 2016. pp. 102\u0026ndash;17. 2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaygısız N, et al. Evaluation of Toilet Habits and Self-Awareness of Constipation Statuses Among Young Adults From Different Faculties At Acibadem University. Turkish Med Student J. 2021;8(1):22\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Functional bowel disorders, screen time, toilet behavior, gut–brain axis, sedentary lifestyle","lastPublishedDoi":"10.21203/rs.3.rs-9279150/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9279150/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground/Aims:\u003c/h2\u003e \u003cp\u003eScreen-based sedentary behaviors have been increasingly implicated in functional bowel disorders (FBDs); however, the role of contextual screen use, particularly during defecation, remains unclear. This study aimed to evaluate the association between total screen time, toilet-related screen use, and FBDs in adults.\u003c/p\u003e\u003ch2\u003eMaterials and Methods:\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, 812 adult participants attending a tertiary gastroenterology outpatient clinic were evaluated using structured questionnaires. Data on total daily screen time, duration of toilet use, and smartphone use during toilet time were collected. FBDs were diagnosed according to Rome IV criteria. Associations were analyzed using univariate and multivariate logistic regression models.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eFBDs were identified in 29% of participants. Total daily screen time was not significantly associated with FBDs (p\u0026thinsp;=\u0026thinsp;0.094). In contrast, a strong dose\u0026ndash;response relationship was observed between toilet-related smartphone use and FBD prevalence, reaching 75.9% among individuals using smartphones for more than 45 minutes during toilet time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In multivariate analysis, toilet duration remained an independent predictor of FBDs (OR: 1.714, 95% CI: 1.426\u0026ndash;2.059, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eToilet-related smartphone use, rather than total screen exposure, is significantly associated with functional bowel disorders. These findings suggest that the behavioral context of screen use may influence bowel function through gut\u0026ndash;brain axis mechanisms. Assessment of toilet-related screen habits may represent a simple and modifiable target in clinical practice.\u003c/p\u003e\u003ch2\u003eClinical trial registration\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Beyond Total Screen Time: The Strong Association Between Toilet-Related Smartphone Use and Functional Bowel Disorders","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-06 09:35:51","doi":"10.21203/rs.3.rs-9279150/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-27T07:19:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-20T10:10:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-18T21:06:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2026-04-18T21:03:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aa4c62c6-cb22-467c-983e-7154e2e82bfd","owner":[],"postedDate":"May 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T09:35:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-06 09:35:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9279150","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9279150","identity":"rs-9279150","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}