This fact has been known by workers in resthomes for a long time. And not just #2 but #1 or both at the same time. But the medical industry has always refused to believe the very eyewitnesses who watched it happen as it happened. “Can’t happen” and they try to blame other causes. It happened to my father but he recovered, and a good friend just lost his wife to the very same.
The stress of pushing too hard to relieve yourself can and will cause heart attacks and strokes. Anyone who has worked in a resthome has witnessed it. I have talked to only one doctor who confirmed this as real, and only because he personally watched it happen to one of his own elderly family members.
In addition to heart attack or stroke, the straining might also result in a burst Aorta.