Beyond total screen time: toilet-related smartphone use and disorders of gut-brain interaction

Abstract

Abstract Background/aims Screen-based sedentary behaviors have been increasingly implicated in disorders of gut-brain interaction (DGBI); 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 DGBI 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. DGBI were diagnosed according to Rome IV criteria. Associations were analyzed using univariate and multivariate logistic regression models. Results DGBI were identified in 29% of participants. Total daily screen time was not significantly associated with DGBI (p = 0.094). In contrast, a graded association was observed between toilet-related smartphone use and DGBI prevalence, reaching 75.9% among individuals using smartphones for more than 45 min during toilet time (p < 0.001), although this highest-exposure category comprised only 29 participants. In multivariate analysis, toilet duration remained independently associated with DGBI (OR: 1.692, 95% CI: 1.408–2.034, p < 0.001). In a multivariable model including both toilet duration and toilet-related smartphone use, both remained independently associated with DGBI. Toilet-related smartphone use showed the stronger association (OR per category increase: 1.634, 95% CI: 1.254–2.127, p < 0.001), while toilet duration also remained significant (OR: 1.283, 95% CI: 1.010–1.628, p = 0.041). Conclusion In conclusion, toilet-related smartphone use, rather than total daily screen time, was associated with DGBI in adults, and this association persisted after adjustment for toilet duration and measured confounders. A graded association was observed between increasing toilet-related smartphone use and DGBI prevalence. However, given the cross-sectional design, reverse causality and residual confounding cannot be excluded. These findings should therefore be considered hypothesis-generating and support prospective studies to determine whether toilet-related smartphone use is a cause, consequence, or behavioral correlate of DGBI. Clinical trial registration Not applicable.

The authors' abstract, as published at the source. BMC Gastroenterology, 2026 · DOI ↗