After taking a break from his family’s attempted buyout of a liberal media clan to fall even further off the wagon, Succession’s Kendall Roy had an unwanted surprise waiting for him when he returned to the Pierce estate’s guest quarters. While his father was counting on him to help move the Pierces to sell, Kendall shat the bed—literally. The relapse of Succession’s perennially struggling addict didn’t end up derailing Logan Roy’s takeover bid—$25 billion buys a lot of high-thread-count linens—but it was the latest and most pungent humiliation for a character who’s spent the season trying to hit bottom, and doesn’t seem close to it yet.
Aside from reading like an allusion to those apocryphal “Diaper Don” stories from Donald Trump Jr.’s alcohol-fueled college years, perhaps the most pressing question about this episode is: Wait, does this really happen?! Followed by the corollaries: How serious is this? When and why do individuals with severe substance abuse problems, uh, defecate themselves while unconscious? And most importantly, how best can viewers of prestige comedy-dramas learn from this fictitious bowel movement to better modulate their own intake of controlled substances?
First of all: Yes, fecal incontinence can occur as a result of severe and extreme substance abuse behaviors, according to Benjamin Lebwohl, an assistant professor of epidemiology at the Columbia University Mailman School of Public Health and a member of New York City’s Citywide Colon Cancer Control Coalition.
“Loss of bladder control when unconscious is far more common than loss of bowel control,” Lebwohl says. “In both situations, the urge to ‘go’ usually wakes us up, but it is a more likely scenario for the bladder to fill up with urine after a night of heavy drinking, since alcohol can spur the production of urine by suppressing anti-diuretic hormones.” These hormones, also known as vasopressin, are responsible for regulating water levels in the blood and filtration through the kidneys.
In general, fecal incontinence itself is not especially uncommon. Pharmacologist Dr. Jun-Xu Li of the University of Buffalo’s Department of Pharmacology and Toxicology says it’s a symptom present in about 2 to 7 percent of the population, depending on what studies you’re looking at, although primarily it afflicts elderly populations.
Youthful drug and alcohol abusers pooping themselves in their sleep is comparably rare—so rare, in fact, that many of the addiction treatment specialists and primary care physicians interviewed for this piece, including the medical director of Hazelden Betty Ford’s Youth Continuum, Dr. Joseph Lee, could not recall a single instance from their peers’ experiences or their own.
“College kids have all kinds of stories,” Lee said, “but even there it’s not common.”
The scope of Kendall’s substance abuse on Succession covers (at least as currently depicted) serious issues with both alcohol and cocaine, the latter varying in quality and purity, sometimes purchased in public parks by street-level dealers. Of the two, most of the medical professionals surveyed for this piece believed that Kendall’s alcoholism was the more likely causal factor for his involuntary bowel movement.
“Both alcohol and cocaine can wreak havoc on the bowels,” Lebwohl says. “Alcohol is directly toxic on the gastrointestinal tract and, when consumed in large amounts, causes stomach injury (hence vomiting) and injury to the small intestine, resulting in diarrhea.” This feature, Lebwohl and others noted, can combine with alcohol’s heavily sedative effect and its ability to relax both the central nervous system and the network of involuntary smooth muscles involved in the control of the body’s internal organs.
Lebwohl notes that cocaine’s effect on blood vessels can restrict blood flow to the intestines, leading to an internal injury called ischemic colitis that can manifest itself externally in the form of bloody diarrhea. But, by all apparent indicators, Kendall’s condition on Sunday’s episode was not related to ischemic colitis.
(That said, medical professionals, including Li, cautioned that it was difficult to assert what caused the incident, given the incomplete nature of information at hand. In a future episode, Succession viewers may learn that Kendall’s accident was precipitated by a mild cocaine-induced seizure, opioid withdrawal, or damage to the intestines caused by opioid use, clinically known as narcotic bowel syndrome.)
In most cases of alcohol-induced fecal incontinence, according to Lebwohl, the internal injuries responsible “are typically reversible with time and abstinence.” So, Kendall’s got that going for him, unless the extent of his alcoholism is worse than viewers have yet seen. A long-term serious drinking problem, according to Li, can destroy the body’s enteric nervous system over time, decimating this autonomous meshlike system of neurons and preventing it from properly regulating the gastrointestinal tract.
“But if this is the case,” Li says of Kendall, “most likely he [has] had this kind of accident before.” (While conceding that he was also simultaneously hungover and groggy, it’s worth noting that Kendall did not look especially surprised at the discovery of his beshitted bed.)
As a word of caution, Lee hopes Succession viewers understand that incontinence—even fecal incontinence—is hardly ever the wake-up call that pushes an addict to finally seek help. Loss of a job, severed relationships with friends and loved ones, the anguish of having to lead a double life, and many other more emotionally and socially painful ramifications tend to be defining moments, rather than embarrassing scatological gaffes.
“People with severe substance abuse issues suffer,” Lee says. “Incontinence issues are usually just the tip of the iceberg of their troubles in life.”