Why didn't I get the symptom of public defecation?

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There are specific combinations that unlock symptom combos in Plague, INC. I was playing as a virus (which mutates uncontrollably) and I had a ton of points to apply after infecting everyone. When I picked the path for public defecation (requirements), I did not receive the notification that the combo unlocked (nor the achievement) before everyone died.
Is there a specific path or time that these symptoms need to be unlocked with ?
I took the unlocking path of going from the bottom to the top:
(From Insomnia, upward to Diarrhea)
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Can you poop yourself and not know?
If you have urge fecal incontinence, you will know when you need to pass stool but not be able to control passing stool before reaching a toilet. If you have passive fecal incontinence, you will pass stool or mucus from your anus without knowing it.What causes no urge for bowel movement?
Damaged nerves disrupt your rectum's ability to store and get rid of waste. Because of disrupted signals between the colon and the brain, you may not feel the urge to have a BM. This often causes constipation and BM accidents. Reflex bowel problems may cause a sudden, unplanned BM when the rectum is full.Can you poop without the urge?
In some cases, you may not be able to hold in your poop. Fecal incontinence is the loss of control of gas or poop to the point it causes distress or discomfort. People experiencing fecal incontinence are often unable to stop the sudden urge to poop.What is toilet syndrome?
Toilet refusal syndrome (TRS) is a common, benign disorder in toddlers defined by the use of diapers and refusal of toilet for defaecation, but has not been described systematically in preschool children yet.Why Didn't You Stop Me?
Sources: Stack Exchange - This article follows the attribution requirements of Stack Exchange and is licensed under CC BY-SA 3.0.
Images: Enric Cruz López, Michelle Leman, Ketut Subiyanto, Kelly