(This story was originally published in 2019.)
It can be pretty, um, crappy dealing with bowel issues.
Figuring out what’s normal and what isn’t can be a challenge if you don’t know what to look for. Stools come in all shapes and sizes and can shift forms depending on what you’re eating or what is going on in your life at the moment.
“Bowel movements change from person to person depending on his or her diet, physical activity, how much water they consume and what medications they take,” said M. Nuri Kalkay, a retired gastroenterologist and health blogger.
Everyone has their own barometer of how often their body is used to going and what a typical stool looks like for them. But what if things change and you see something beyond the norm in the toilet? We chatted with some experts to determine what bowel habits are aren’t so ordinary and might require a trip to the doctor.
Black and/or tarry stools
Jeffery M. Nelson, surgical director at the Center for Inflammatory Bowel and Colorectal Diseases at Baltimore’s Mercy Medical Center, said if your poo is black, “not just dark brown,” you should be concerned.
“This means bleeding is happening from an upper GI source like the esophagus, stomach or small bowel,” he explained.
There are some exceptions to this: If you’re taking iron supplements, for example, your stools may appear dark green to the point where they almost look black. If you’ve taken bismuth medication like Pepto Bismol, that can also make your stools look almost black. It’s always best to check with a doctor if you’re unsure.
Bright red blood in your stools
If you find blood in your stool either by itself on the toilet paper, in the water or streaked in the stools, this can indicate a bleeding source from the anal canal or a low rectal source.
“Things like internal haemorrhoids, anal fissures, rectal polyps or rectal cancers can all do this,” said Nelson. All of these are reasons to see a doctor.
Maroon-coloured stools
If your stools are this colour, then they’re likely also more liquid in consistency and paired with an unpleasant, distinct odour. According to Nelson, this can indicate bleeding from the very end of the small bowel or the colon.
“Diverticulosis and arteriovenous malformations are the classic causes of this presentation,” and a reason to go to the emergency room, he said.
Pale, oily and especially foul-smelling stools
“This finding is called steatorrhea and is due to excess fat in the stool,” explained Chris Carrubba, an internal medicine doctor in Jacksonville, Florida.
Carrubba said steatorrhea is often seen with malabsorption syndromes, pancreatic insufficiency and biliary disease. “The presence of steatorrhea indicates difficulty absorbing fat and these patients are at risk of developing deficiencies in fat soluble vitamins,” like vitamins A, D, E and K, he said.
Stools that are different than your typical bowel movements
Your body is a creature of habit in a lot of ways. For example, if you consistently have smooth, long sausage-like stools and suddenly they change to a completely different size, you should speak to your doctor.
“Pencil thin versus log-like routinely could mean that an inflammatory condition may be present such as Crohn’s or infection,” said Karen Soika, a general surgeon in Greenwich, Connecticut.
If the consistency of your stools has changed to watery or diarrhoea, this could signify irritable bowel syndrome, an infectious cause or an inflammatory bowel disease such as Ulcerative colitis.
IBS or infections can also increase constipation.
Watery diarrhoea after a camping trip
This can be due to giardia, “a protozoal organism that is found in freshwater and the reason that you should always boil and sanitise water from mountain streams or lakes,” Carrubba said.
Ingestion of this organism can result in giardiasis, which leads to abdominal pain and persistent, watery diarrhoea. The issue can be treated with antimicrobials. In addition to drinking contaminated water, you can also be exposed to giardia by eating uncooked vegetables or fruits that were rinsed in contaminated water and by improperly washing hands after coming into contact with faeces or an infected human or animal.
Mucus in the stool
This is usually due to inflammation of the intestines, said Peyton Berookim, a gastroenterologist in Los Angeles. He noted that the condition can be seen in inflammatory bowel diseases like ulcerative colitis or Crohn’s. It can also be due to inflammation caused by a bacterial infection or IBS.
“Mucus associated with blood and or abdominal pain should not be ignored and requires medical attention,” he explained.
Hard or infrequent stools
This signifies constipation and is usually caused by a lack of fibre in your diet, as well as low water intake. However, this issue may also be caused by medications, blockages in the intestine, or in more rare cases, colon cancer.
“Constipation can be treated in many ways and I always begin with increasing fibre and water intake. The recommended daily intake of fibre is at least 25 grams and the amount of water needed varies from person to person,” said Jack Braha, a gastroenterologist at Brooklyn Gastroenterology and Endoscopy Associates.
Laxatives are available over-the-counter to help with this issue and work by either increasing the motility in your gut or increasing the amount of water delivered to the colon, Braha said.
“But for symptoms that do not rapidly improve or begin after the age of 50, it is important to seek advice from a gastroenterologist in order to determine if further testing like a colonoscopy is needed to check for more serious issues such as an intestinal obstruction or colon cancer,” he said.
Loose, watery or frequent stools
“Diarrhoea is common after eating bad food or from an infection and should not last more than a week in most instances,” Braha explained.
Loose stools may be a cause for concern if the diarrhoea lasts longer than two weeks or when it is in conjunction with bleeding, weight loss or symptoms that keep you awake at night.
“When diarrhoea is not from an infectious source, we look for other common causes like lactose intolerance, irritable bowel syndrome, inflammatory bowel disease or celiac disease,” Braha said. “Gastroenterologists can usually find the cause of diarrhoea by checking certain blood tests, stool tests and performing a colonoscopy.”
Generally, it’s a good idea to make an appointment with your doctor if you’re concerned about your bowel movements at all. Your poo may be trying to tell you something.