As a gastroenterologist, I talk sh*t for a living. There’s no exaggeration or hyperbole here. I go to work every day and talk to people about poop. Sounds crass? It shouldn’t—please forgive me. I feel blessed to have the opportunity to help people deal with serious issues. Talking about stools is often the first step in identifying a problem with your intestines. From my perspective, it’s odd the that old English word for defecation is a curse word. It’s like we’ve been conditioned to avoid talking about a normal bodily function. Ironically, our society is becoming more open about what goes down in the bedroom—what goes down or doesn’t go down in the bathroom remains off limits.
In my humble efforts to help people with with their bowels, I have to ask people what their stools look like. I realize that this isn’t a question people hear every day. I haven’t even heard the topic of stool pop up in a barbershop—you know they talk about everything in barbershops.
Before becoming a gastroenterologist, I didn’t realize how many people never look at their stools or toilet paper after wiping. It’s almost like some people close their eyes, wipe, flush, and run.
This practice is dangerous since your stool’s appearance can signal a health problem. A 2003 study including 1611 people found that only 27% of people looked at their poop or used toilet paper with every bowel movement. In the same survey, an astonishing 6% of people never looked at their poop. The study also revealed that people who never looked at their stool were less successful in reporting bloody stools.
Most people don’t have open conversations about their poop. Since my blog is a safe space, I want to share 7 things that your poop says about your health.
1. You have regular, healthy bowel movements. Yes, I’m going to talk about the Bristol Stool Chart.
Before you grab a magnifying glass or send me poop pics in my DMs—don’t freak out. Most variations in poop are normal. Let’s break it down.
Normal stool size and shape
Gastroenterologists rely on the Bristol Stool chart to show people how normal stools look. A healthy stool typically has the shape of sausage or a snake (Type 3 and 4).
Normal Stool Frequency
Don’t worry if you don’t have bowel movements every day. Your frequency may be reasonable as long as you are not having hard, painful stools. A recent study in the American Journal of Gastroenterology showed the average rate of bowel movements ranges from 3 times per day to 3 times per week. You probably don’t need to see me in clinic if you fall in this range, aren’t having pain, and your stool has a normal color.
Normal Stool Color
Any shade of brown is normal. Stool can come in a lot of colors, but red or black stools are typically the most concerning hues for adults. I’ll break down abnormal stool colors in a second.
Stools with mucus are usually normal.
The intestines naturally produce mucus. As a result, mucus in the stool is relatively normal.
If you have diarrhea, abdominal pain, and mucus in your stool, the mucus could be a sign of inflammation or an infection.
2. You’re bleeding. You should unquestionably talk to a health professional about red or black stools.
Black Stool (melena)
Black stool is concerning for bleeding in the upper gastrointestinal tract (i.e., esophagus, stomach, and the first portion of the small bowel). Blood turns black when it’s exposed to digestive enzymes and the bacteria of the intestines. It only takes about 3 tablespoons of swallowed blood to turn stool black. Thus, even a severe nose-bleed can cause melena, the medical term for black stool due to bleeding. Melena typically has a liquid, non-solid appearance. It also smells distinctively different from a regular stool.
Bleeding isn’t the only cause of black stools. Certain medications and foods can also give your poop a black appearance. Pepto-Bismol, iron tablets, beets, and black licorice are also common culprits. Black stools from these causes are usually solid and do not have the unique smell of melena.
If you have black liquid stools, you should definitely contact a medical professional or go to the emergency room—you may be experiencing an upper gastrointestinal bleed.
When it comes to stool, red is not the color of love. Obviously, red colored stools are concerning for bleeding. Hemorrhoids and anal fissures are typically the most common causes of bloody stools. Since colon cancer is also a cause of bloody stools, red stools or blood on toilet tissue warrant a conversation with a physician. After finding colon cancers in younger people (under the age of 40), a colonoscopy should be a part of that conversation in my opinion. Similarly, inflammatory bowel diseases like ulcerative colitis and Crohn’s disease can also have bloody stools as a symptom.
As a weird aside, people with color blindness may have a difficult time appreciating the redness in bloody stools. For those who are colorblind, what you do with this information is out of my hands—I’m just the messenger.
3. Change in stool caliber (pencil-thin stools)—There’s a narrowing somewhere in your colon.
Stool changes size and shape all the time. Most of these changes aren’t even worth mentioning. However, recurrently having extremely thin stools is somewhat concerning for a narrowing in the colon. A narrowing could be due to diverticular disease, a stricture from inflammation, or a large polyp/ cancer. Nonetheless, this change in your stool deserves further attention.
4. Floaters: You are gassy.
Floating stool isn’t really a big deal. The gas trapped within stool is typically the underlying cause of floating stool. Bacteria that live in the gut produce gas by fermenting poorly digested food into a variety of gases. These gases give poop a degree of buoyancy.
As long as the floating stool isn’t oily and greasy, it’s nothing to cause worry. Check out my article about gas and bloating.
5. You ate a lot of veggies- Green/Yellow/Orange Poop
Overall green stools are usually normal. Eating green colored foods can give stools a greenish appearance. This typically is the result of eating a lot of spinach and other green veggies. In some cases, if stool passes through you too quickly, unabsorbed bile salts can also give poop a greenish look.
Again, these colors are typically due to the foods you are eating. Eating massive amounts of carrots make your poop orange-ish.
Not absorbing fat is a possibility if the stools look greasy.
6. You are constipated- small pebble-like stools.
Constipation is the reason God created gastroenterologists. It’s the most common issue I see. If your stools are small and pebble-like (refer to the Bristol Stool Chart- type 1 and 2) you may have a problem with constipation. Hard, ball-like stools are due to the colon grinding and dehydrating stool over time. Hence, studies show that the Bristol Stool Chart correlates with intestinal transit time. If you have pebble-like stools every day, there’s a chance that you have an issue with constipation.
7. Diarrhea—it kind of speaks for itself.
That skit from the Chappelle show was funny, but there’s nothing funny about life with recurrent diarrhea. Chronic diarrhea could indicate many different issues depending on the circumstances and other symptoms accompanying diarrhea. Food intolerances are a common cause of diarrhea. Intolerances to lactose, fructose, sucrose, and gluten are relatively common. Diarrhea associated with severe abdominal pain is concerning an underlying infection, irritable bowel syndrome with diarrhea predominance, or inflammatory bowel disease (ulcerative colitis or Crohn’s disease). This list is just the tip of the iceberg when it comes to diarrhea. Needless to say, if you are always experiencing diarrhea, seek the opinion of a health professional.
What’s the Bottom line?
- Look at your stool.
- Don’t over obsess since most variations of stool are normal
- Black or red stool can indicate bleeding. Seek medical attention if you are experiencing these.
- Don’t send me poop in my DMs (seriously, no poop pics).