Passing Screening to Smart Toilets: The Potential of Digital Bowel Movement Biomarkers

For gastroenterologists, accurately assessing bowel habits has long been a challenge. Traditional methods rely on patient self-reporting, which can be subjective and prone to bias. Two recent studies explored the exciting potential of "smart toilets" equipped with sensors and machine learning to provide objective, real-world data on bowel movements (BM). Yes, this is the same technology that won the Ig Nobel Prize in Public Health in 2023. At the time, it was reported that the “smart toilet” could perform dipstick urinalysis, a vision system for defecation analysis, and an anal print, which was of course telecommunicated results and analysis. Let’s explore some of the most recent updates.  

Objective Assessment and Long-Term Monitoring
In the first study, researchers focused on the feasibility and long-term utility of smart toilets. They recruited four healthy volunteers and monitored their bowel habits at home over an average of 109 days. The smart toilet discreetly tracked BMs using pressure sensors and stool analysis, which captured data on frequency, timing, consistency (using the Bristol Stool Form Scale), and even stool images. 

The results were promising. The smart toilet successfully captured detailed information on bowel habits, with minimal disruption to the participants' routines. Notably, there were no significant changes in bowel habits over the monitoring period for three participants, suggesting the technology can provide stable data for long-term monitoring to objectively evaluate conditions and treatment effects for many digestive diseases.  

Beyond Frequency: The Potential of New Biomarkers
The second study, conducted by a separate research group, delved deeper into the range of data obtainable from smart toilets. They monitored the bowel habits of 11 participants over five weeks using a smart toilet system equipped with similar sensors and machine learning algorithms. 

This study not only confirmed the feasibility of using smart toilets for objective assessment but also introduced a new concept, "eu-tenesmus." This term describes the time interval between the final stool passage and the end of defecation. This finding shed light on a previously unexplored aspect of defecation physiology which might have diagnostic value in the future, and perhaps even identifying a new phase in the BM cycle.  

Personalized Medicine and Tailored Interventions
Both studies highlight the potential of smart toilets to revolutionize the way we understand and manage bowel dysfunction. By capturing a wider range of data points than traditional methods, smart toilets can provide a more nuanced picture of bowel health. This detailed information can be used to: 

• Improve diagnosis: More objective data can aid in the diagnosis of conditions like constipation, diarrhea, and irritable bowel syndrome (IBS). 
• Develop personalized treatment plans: By identifying individual bowel patterns, doctors can tailor treatment strategies to optimize gut health for each patient. 
• Monitor treatment efficacy: Smart toilets can be used to track a patient's response to treatment and adjust medication or lifestyle modifications as needed. 
  

The Future of Gut Health Monitoring
The research on smart toilets is still in its early stages, but the potential benefits for gastroenterology are undeniable. As technology advances, smart toilets are likely to become even more sophisticated, capturing an even wider range of data points and offering even more precise insights into bowel health. This holds the promise of a new era of personalized medicine for gut health that could allow gastroenterologists to provide more effective and targeted care for their patients.