Sonia Grego has been thinking about toilets — and more particularly, what we dump into them – for the last ten years. “We are laser-focused on stool analysis,” says the Duke University research professor, unconcerned by the fact that he is talking about bodily functions.

“We believe there is a huge untapped market for health data. And because of the general reluctance to having anything to do with your stool, this information is not tapped.”

Grego is a co-founder of Coprata and is working on a toilet that analyzes waste using sensors and artificial intelligence; she expects to have an early model ready for a pilot study in nine months. “Since it was first introduced in the second half of the nineteenth century, the toilet that you have in your home has not functionally changed in its design,” she adds.

Of course, there are already loos with genital-washing capabilities and heated chairs, but they are rudimentary in comparison to what Grego envisions. “Every other aspect of your life has been enhanced, including your electricity, communication, and even your doorbell.”

The smart toilet is here, and it has the potential to be a massive market — in the developed world, anybody who can use a toilet several times per day. Grego goes on to say that she can "certainly envision a world" in which "every household" has a toilet that does more than just flush excreta.

There are a slew of businesses vying to be the first to market with it — a race to the bottom, if you will.

Smart toilet designers think the toilet may one day become the ultimate health monitoring device. Grego thinks her device will offer "information related to cancer and many chronic diseases" by analyzing and tracking feces samples and sending the data to an app.

“Having technology that tracks what is normal for an individual could provide an early warning that a checkup is needed,” she adds. For general customers, it will bring piece of mind by creating “a healthy baseline,” she says.

The gadget may offer physicians with useful monitoring for individuals with particular diseases like inflammatory bowel disease. “Knowing when to escalate or de-escalate treatment is extremely difficult,” she adds.

“Biomarkers found in the feces can provide that information.”

She believes that, at some time, a smart toilet will be able to offer lifestyle recommendations, such as telling you to eat more fiber or specific minerals, or determining what meal caused an unpleasant gastrointestinal episode. “Nutrition science is really moving in the direction of personalised nutrition,” Grego adds.

“Our technology will enable this because you already have information about what you eat, but we can make obtaining information about what comes out seamless.”

Because urine is simpler to collect and analyze, Joshua Coon's university lab is focusing on it for his toilet invention. Although he claims to be in discussions with industry experts, he sees himself as a "smart toilet enthusiast" rather than someone who is rushing to bring a product to market.

“There are thousands of different small molecules known to exist in urine, and they give you insight into what's going on,” says Coon, a chemical and biochemistry professor at the University of Wisconsin-Madison.

Two individuals – one of them was Coon – preserved every urine sample for ten days in a short research he performed. “It turns out that you can see when an over-the-counter medication enters the system and clears out; you can see molecules that correlate with how well you slept, how much fat you had in your diet, and what your calorie intake was.”

According to him, the research wasn't designed to look at long-term health, but the implications are there. “When combined with health records and lifestyle data, many of these molecules are almost certain to correlate with important disease risk and be able to predict a person's need for intervention much more accurately.

If one had the technological capacity to perform these measures in a toilet, that would be the vision.”

Similar developments have occurred in other places. Panasonic introduced a smart toilet in China in 2018 that tested urine and monitored body fat. The Japanese company Toto presented its "wellness toilet" — a concept, but one it is working on – at the important annual Consumer Electronics Show this year (it previously developed a toilet that analyses urine flow).

Its sensors, which include a smell sensor, would attempt to identify health issues and diseases like stress, as well as provide lifestyle recommendations. The toilet, according to one picture given by the business, will email you a recipe for salmon and avocado salad.

Stanford School of Medicine researchers are developing equipment that can analyze feces (including "stool dropping time"), monitor the velocity and color of urine, and test it. The researchers have collaborated with Izen, a Korean toilet manufacturer, and expect to have prototypes by the end of the year, according to a Wall Street Journal story published this month.

Izen created a scanner that can recognize the physical traits of whomever is sitting on the toilet – or, in the researchers' words, "the distinctive features of their anoderm" – in order to distinguish between users (the skin of the anal canal). Your "analprint," like your fingerprints, seems to be one-of-a-kind.

We're ready, according to Vik Kashyap (well, maybe not scanners; according to Stanford's user acceptability survey, "the least favoured module is analprint"). Toi Labs, Kashyap's firm, has been working in the smart toilet area for over two decades and has a long history of interest in gut health (he successfully treated his own ulcerative colitis by ingesting parasitic worms).

Other businesses' efforts at the smart toilet have failed, but he believes now is the right moment. Not only is it commonplace to monitor our data with wearables like an Apple Watch or a Fitbit, but we are also less apprehensive about it.

This, according to Kashyap, is due to a rise in interest and study into the microbiome and our gut health, including feces, which "has made this topic less taboo."

He also believes that the epidemic has hastened things, citing the shortage of toilet paper as evidence of people's concern about how they would wipe their bottoms, while labs have been analyzing sewage to trace the virus. “Finally, the cost of delivering sensor-based Internet of Things systems to consumers has decreased significantly.

People are starting to realize that their house will change over time as a result of products like Alexa.”

Kashyap has created TrueLoo, a toilet seat that can be attached to an existing toilet and recognizes the user based on their phone (a majority of Britons carry their phone to the toilet, according to one study) or a mix of physiological parameters: “What do they weigh? “How are they sitting on the seat?” says the narrator.

It then examines excreta “using optical methods, such as volume, clarity, consistency, and color.” It basically recognizes when someone has aberrant patterns and then documents those patterns and generates reports that doctors may utilize to aid in the treatment of a range of conditions.”

TrueLoo is currently focusing on the older adult market – people who are more at risk of genitourinary and gastrointestinal problems, such as those in residential care homes – but, according to Kashyap, “we very much have an eye towards this being a consumer product that will be used by anyone who has a toilet.”

When Kashyap first considered waste analysis, he decided to pursue a career in biochemistry. “However, I've learned over the years that the visual analysis realm has a lot of amazing technology,” he adds. It's also a lot less expensive.

“People think to themselves, ‘We'll put all these complicated sensors in a toilet and do chemical analysis.' When you start doing that, the price starts to rise.

It's not feasible to tell someone, "I'm going to replace your $20 toilet seat with a $2,000 toilet seat, or a $12,000 toilet."

Kashyap believes that some form of the smart toilet “will be the most important home medical product in the future,” though he acknowledges he is prejudiced. Wearables have their limitations, but the toilet will provide a much more in-depth understanding of a person's health.”

Is this a step too far, putting your analprint on the internet and analyzing the composition of your bowel movements? “Can it be kept secure?” wonders Eerke Boiten, a cybersecurity expert at Leicester's De Montfort University.

“What kind of organization has this information?” With whom will they share data? With what data will it be combined?

Will there be any openness about the data's destination? We don't even have a complete understanding of the dangers in this area. We need to do a lot more study on this.”

Many individuals "wouldn't like cameras pointing up their bottoms for very good reasons," says Phil Booth, the organizer of MedConfidential, a campaign for medical record confidentiality. Under the supervision of a medical expert, however, he claims that “there are not necessarily inherent privacy risks” in utilizing a smart toilet as a medical device.

However, if the data generated by ordinary consumer usage was held by a business, things could get interesting: “You may trust that particular company, but every company is pretty much buyable by Google, Facebook, or Amazon. Then, what I believed was for my own health monitoring has become grist for business concepts I don't understand.”

People purchased Fitbits “thinking it was just a cool new item to monitor their exercise,” according to Booth, and then Google acquired it. All of a sudden, all of this very valuable data is swallowed by a business with different goals.”

For some years, Google has had its eye on the multitrillion-dollar health industry, with the goal of becoming the market leader in health data — controversially, it has had access to the health data of 1.6 million NHS patients and 50 million Americans. Is Google curious in how you use the restroom? It did, after all, patent a toilet seat sensor in 2016.

“What data are companies linking together?” Booth asks when it comes to information about your body waste. What exactly are they attempting to figure out about you? What are you being profiled for? They're called'smart houses,' but they're really surveillance homes."

Stool and urine samples may reveal a lot of information about you, including your illness risk, your diet, your level of activity, how much alcohol you consume, and if you use medications. Even something as simple as the time of day you go to the bathroom — going late at night, for example, indicates insomnia – may show illnesses like melancholy or anxiety.

Where does it all come to an end? Could the police or anyone conducting surveillance follow you using your analprint and the smart toilets you use in public and at home? At a police station, you may be requested to produce a print.

Imagine a future in which smart toilets in businesses could detect whether workers were pregnant, on drugs, or at danger of physical or mental ill-health, implying that they were possibly less productive or likely to miss work. “Think about Texas,” Booth adds, referring to the state's newly toughened abortion laws.

“If you can tell if someone is pregnant by looking at their feces, the question becomes, ‘Are they looking for an abortion?' That's Gilead level, and it's science fiction, but it conveys the danger.”

It's not so far-fetched to envision parents employing technology to monitor their adolescent children's drug use. “The privacy line is stepped over once you start measuring something that is of the body,” Booth adds.

“The bowel movement is private if you don't measure what's going on with someone's bowel movements.”

This is a frightening idea, but, as Booth laughs, governments are unlikely to require smart toilets. People who are into the "quantified self" trend, he adds, will always be glad to measure and monitor themselves. If smart toilets are deemed clinical equipment gathering medical data, "then it's a straight medical breach risk – not unique to toilets, but because you've turned the toilet into a medical data-generating experience," according to the report.

“Are they properly managing those risks?”

Coon is also aware of the problems. “Do insurance companies have access to the contents of your urine? You can envision the obstacles, but if the technology is there and there is a benefit, people will find out how to overcome them.”

“From my perspective, this is basically part of your medical record,” Kashyap adds. This would most likely fall into the same danger category – and, at least in the United States, medical records are heavily protected.”

Is the smart toilet on its way to becoming a standard bathroom fixture? This is a question that only applies to the developed world.

If you want to speak about toilet inequality, almost half of the world's population — 3.6 billion people – lack access to basic sanitation, much alone a toilet that can monitor sleep quality and fiber intake. Those working on smart toilets, on the other hand, are hopeful.

Coon explains, "It's about figuring out how to get the technology we have in the lab into a toilet at a scale that's affordable and robust." “That is the problem. It might be ten years or thirty years down the road, but I believe it will happen.”

Thanks to Emine Saner at The Guardian whose reporting provided the original basis for this story.