Taking the Taboo out of POO! or MoveOn.ARG
When I take a history from a patient, one of the most important questions I ask about is their bowel movements. Granted, the topic is not one most people want to discuss, yet gastrointestinal health is critical for our over all physical and mental wellbeing. Having patients identify their stool consistency based on the Bristol Stool Chart (there is a link at the end of this article to the chart) helps me start the conversation. The chart is a useful tool, however, there is some disagreement regarding some types. For instance, some authors view Type 3 as normal. In my opinion (and other healthcare docs agree), it is not normal and, rather, a lesser form of constipation. Bowel moments should occur at least once a day, effortlessly. Some medical references state that constipation is when you don’t eliminate after three days. I strongly disagree with this assessment.
The Bristol Stool Chart Types
Type 1: Separate hard lumps, link nuts (hard to pass) constipation – abnormal
Type 2: Sausage shaped and lumpy (hard to pass) constipation – abnormal
Type 3: Like a sausage with cracks on the surface leaning toward constipation – abnormal
Type 4: Like a sausage or snake, smooth and soft, may have a curve – easy to pass and is normal
Type 5: Soft blobs with clear cut edges – considered a normal variant
Type 6: Fluffy pieces with ragged edges, a mushy borderline abnormal stool leaning toward diarrhea
Type 7: Watery, no solid pieces – entirely liquid – abnormal
Adapted from the Bristol Stool Chart
The Bristol chart does not include important symptoms such as, color, smell or symptoms such as burping, foul smelling gas and bloating. All symptoms tell a story – if you have GI symptoms keep a 7-day diary (at the end of the article there is a link to the form that you can download) and also track the symptoms on the same form. Bloating right after eating is different than bloating 3 hours after eating. Good detective work just may result in a clear diagnosis.
What Does an Ideal Bowel Movement Look Like?
Everyone has abnormal bowel moments from time to time due to illnesses or some reaction to a food substance. As it leaves the body it should be effortless (no straining). The color of a healthy bowel movement is brownish and the texture should be soft yet held together. It should not stick to the toilet bowel and may float somewhat. There should be little gas or odor.
A few things about color
Blood in stool – red means that the blood is either coming from your descending colon or the rectum. Blood that is coming from the stomach or intestines is dark and may produce blackish stools. Blood can be an early warning sign of cancer so don’t ignore it. Red beets can produce stool and urine that is red. White or very pale color: not enough bile from the gall bladder digestive juices to add color.
Why is a healthy bowel so important?
If you have chronic GI problems it may mean that you are not absorbing all your nutrients and over time your body will suffer the consequences. GI health is the primary concern I have when assessing bone, heart or thyroid health or any health condition for that matter.
What causes abnormal stools?
Many things can result in chronic abnormal bowel movements. Such symptoms can be a very important piece of information for your health care practitioner to assess. If you have chronic abnormal stools and your health care provider is not paying attention to figuring out the cause, other than recommending medications to deal with symptoms, consider finding a new doctor. Part of your health history should include a diet diary and symptoms assessment.
Constipation – not enough water, fiber or excessive intake of protein. Hypochlorhydria (lack of or low production of hydrochloric acid production). For many people constipation can be easily fixed with dietary changes to a whole foods diet including more water and fiber and making sure there is enough magnesium in the diet. However, if you have been constipated for years it is possible that your large colon is permanently stretched, which means that ongoing constipation is possible. The permanent stretching can also mean that there is nerve damage and the normal movement of the large intestine (peristalsis) is permanently damaged.
Loose stools – Food intolerances such as gluten (Celiac disease), some food sensitivities. Loose stools points directly to malabsorption meaning that vital nutrients are passing right though your body. The transit time of food needs to be slow enough for nutrient intake to take place.
Hypochlorhydria – Really? Is this possible with all the gastric reflux and ulcers? Yes, it is quite common. Once my patients clean up their diet and add HCL (if they need it) their GI symptoms and gastric reflux disappear. I know, it happened to me! DO NOT attempt to use HCL without being assessed first – it could be the wrong thing and you could cause more GI problems.
Enzyme deficiencies – lack of producing various enzymes that breaks down food particles small enough for them to be absorbed. Examples of this include lactase deficiency that results in lactose (cow’s milk) intolerance.
Overgrowth of bacteria in the gut that can be the result of too much carbohydrates (sugar and processed grains) intake along with not enough good bacteria to balance it out.
Candida – overgrowth of yeast in the gut, which also results in abnormal stools and often associated with skin conditions – rashes, eczema etc.
Mucus in Stool
Whitish mucus in stool may indicate there is inflammation in the intestines. Mucus in stool can occur with either constipation or diarrhea.
Skin and our GI Tract – Skin conditions are often caused or made worse by GI problems. Keep in mind that the source of GI problems can simply be poor dietary intake or food sensitivities or intolerances.
Several companies offer stool testing. I suggest a lab such as Genova for a comprehensive stool analysis if a diagnosis is not clear.
OK so this was a brief discussion on GI problems – want more? Workshops online and in the Berkeley area will be posted soon.Want help sorting out your digestive concerns? Call my office to set up an appointment. Appointments can be in person or by phone. 510 898-0933
Most importantly, don’t ignore abnormal digestive issues!
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