“In its extreme form, people become agoraphobic,” Soifer says. “I know people who’ve never dated, never gotten married. I know one guy who had a master’s degree and ran a paper route in the evening, so he knew exactly where a safe bathroom was [if he had to go at work].”

The IPA has a term for “poop-shyness” as well: parcopresis. But this isn’t a medically recognized condition, and is less of an issue for most people, according to Soifer. The relative infrequency of bowel movements means people can usually time them for when they’re in a bathroom that makes them comfortable. In rare cases, like dorm bathrooms, people like Sanchez may not have that option.

Soifer doesn’t deal much with parcopresis—he says he’s rarely seen someone who has both it and paruresis. “People call me Dr. Pee, and I tell them I don’t want to be Dr. Poop as well,” he says. “It’s too much.”

* * *

Even for the rest of us, who don’t suffer a clinical level of anxiety, the public bathroom is a place that has ingrained behaviors and social rituals—leaving space at the urinals, avoiding conversation even with people you know—that we’ve all experienced, if not daily at an office, than out in the world, at restaurants and ball parks and airports. The public collides uncomfortably with the private in the bathroom as it does nowhere else, and the unique behaviors we perform stem from a complex psychological stew of shame, self-awareness, design, and gender roles. If you boiled this stew down, though, it’d come down to boundaries—the stalls and dividers that physically separate us, and the social boundaries we create with our behavior when those don’t feel like enough.

In an increasingly sex-positive culture, it seems like bathroom issues are the last thing most people are reluctant to talk about. Serious attempts to research bathroom behavior or design have been done by just a few people who have been willing to break the taboo. One of these, Nick Haslam, author of Psychology in the Bathroom, explains that we attach “shame and secrecy” to the bathroom from a very early age, and that some of that is evolutionary.

“Part of that is surely due to the fact that we are socialized from an early age to control excretion and taught that failures of control are embarrassing and humiliating,” he told me via email. “And from an early age we learn that excretion is something you do on your own, behind closed doors…Another reason for the taboo is perhaps an entirely adaptive and evolved aversion to bodily waste, which is linked to disease and contamination. To some degree there will always be some anxiety and disgust attached to excretion for this reason.”

But he also notes that talking about bathroom issues wasn’t always this taboo. If we’ve talked about it before, we can talk about it again, and in talking, maybe find ways to ease some of the anxieties people feel in public bathrooms, and reduce the need for us to be so vigilant about policing our behavior.