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One possible reason is straining during bowel movements, which is especially likely if you have diarrhea or constipation

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While many of the respondents were able to share stories and provide anecdotal evidence of the positive impact their efforts were having on victims (e.g., cases identified due to outreach activities, direct services provided, number and type of referrals made, and number and type of investigations conducted), very few were able to produce documentation in the form of formal assessments or rigorous (internal or external) evaluations that could establish that their actions, policies, and procedures were the most effective possible

However, the demarcation between asymptomatic hyperuricemia and gout remains clinically ambiguous as only approximately 50% of patients with prolonged hyperuricemia develop gout within 15 years (Xiang et al., 2024