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Abnormal Stools and Bowel function

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Abnormal Stools, Stool consistency and Bowel function
Is occasional blood in the stool normal?
When to report to your Doctor
what are the signs that may indicate that constipation is due to a serious disease?
What is a healthy stool?
Diarrhoea

What is a Healthy Stool?

Properties of a healthy Stool

It should exit the body effortlessly, without pain and without the need to strain.

It should be the tubular shape of a healthy colon, that is, Banana or Sausage shaped.

There should be little or no foul odour.

A Moist, Firm, Soft, Solid, Bulky, Slippery and Smooth stool will ideally exit in one continuous solid log with the aid of gavity.

It should be a shade of Brown

Consistency of Stool is determined by
1.What you eat.
2.How much you eat.
3.How long the food remains within the gastrointestinal tract. This is determined by intestinal transit and Gut motility.

 

 

Colour

The normal colour of stools is a shade of brown. Any other colour, such as red, yellow, gray, white or green is not normal but could be due to colours of food eaten. Colour can indicate unhealthy stool and should be investigated to address possible serious disease.

Loosely formed stools
may flake off half way out of the anal passage and stick to the rectal and anal passage, which may cause anal itch and create the feeling of incomplete emptying of the bowel. Straining is often required to dislodge this type of Stool from the anal lining for complete emptying.

This type of stool is made when the stool is lacking “adhesion” or bonding, which is a property mainly provided by the presence of large amounts of Bacteria and mucus in the faeces. Bacterial mass can be increased by including soluble fibre, mucilage and resistant starch in the diet. (E.g. Cracked Linseed and an unripe or half ripe Banana)

Watery, liquid stools
are produced when too much water remains in the faecal mass. This may be due to the inability of the colon to reabsorb the water because it did not remain in contact with the colon wall for long enough or due to the secretion of water into the colon due to microbial toxins.
If faecal matter passes through the colon too fast, it is not exposed to the colon wall for long enough to absorb all the water and makes for the emergence of loose, watery stools. Excessive amounts of some types of soluble fibre can cause fluid to be retained in the faecal mass and cause loose, soft stools.

Soluble fibre is important for the formation of the perfectly formed Stool, however, it needs to be consumed with non digestible Insoluble fibre and resistant Starch so that a Solid stool is made.
If the faeces or stool is LIQUID or SOFT, it will be squirted out as in diarrhoea.

Diarrhoea can be caused by:

Toxins (food poisoning) secreted by microbes (Bacteria and Viruses) in food may affect gut motility and cause both vomiting and Diarrhoea.

Infections due to Viruses, Bacteria and Parasites can affect the normal absorption and secretion processes of the Gastrointestinal tract and cause retention of excessive amounts of water and electrolytes in the gut lumen, resulting in Diarrhoea.

Inflammatory disease of the bowel (Ulcerative Colitis and Crohn’s disease)

Malabsorption syndromes—Lactose intolerance, Celiac disease (gluten intolerance) causes retention of water in the lumen

The shape of normal healthy stools is created by the circular shape of the healthy muscular tube of the unobstructed colon and should be Banana or sausage shaped.

Pencil thin stools
are not a good sign and may indicate an obstruction in the colon. Obstruction may be due to a mass in the colon that creates a blockage for the passage of faeces.
When faeces are forced past this blockage, they tend be thinner and acquire a pencil thin shape.
Inflammation, ulceration, polyps in the colon, a tumour or growth can lead to this type of stool.

If you produce this type of stool on a consistent basis you need to visit your Doctor for investigation so that any sinister causes can be eliminated.

Pale or Gray Coloured stool
Normal, healthy stool can be a shade of brown.
The brown colour is due to bile acids called Stercobilin and Urobilin which are produced by bacterial degradation of Bilirubin.
Pale, Gray or clay coloured stools indicate that there is very little Bile being produced.
The liver makes Bile and is stored in the Gall bladder. Bile is secreted into the small intestine in response to the presence of fats. Bile salts emulsify the fats into smaller particles that can be broken down further by enzymes (Lipases) into fatty acids that may be absorbed through the intestinal wall.
Lack of bile secretion may be due to a slow production in the Liver or a blockage of the tubes through which bile travels from the liver to the gall bladder and from the gall bladder into the intestines.

Pale Yellow, Greasy and Foul smelling Stools that may float in the Toilet pan.
This indicates the presence of Fat in the stool. Fat is found in the stool when it escapes digestion and absorption in the small intestine and arrives intact into the Cecum with the waste matter from the ileum.
This indicates lack of Digestive enzymes normally produced and secreted by the Pancreas into the small intestines. This could be due to pancreatic insufficiency, as seen with Pancreatitis, Pancreatic cancer, Cystic fibrosis and Celiac disease.

Pellet like Stools or little lumps
indicate that the stool has remained in the Colon for too long and as a result the Colon has removed all the water within the faeces.
Slow gut transit causes retention of stool and continuous removal of water by the colon .The cause can also be a lack of bulk providing insoluble fibre in the diet. Insoluble fibre holds on to fluid and provides bulk to stool. When stool has no bulk, it cannot distend or stretch the muscular wall of the rectum and the defecation reflex is not created.
This type of stool is difficult to pass and causes constipation. Diets that contain too much food from animal sources and very little from plant sources can contribute to this problem.

Dry or rock hard Stools
are produced by the removal of too much water from the faecal mass due to the retention within the colon of the faecal mass for too long. The dried out stool is hard and difficult to pass, causing constipation. This problem may be due to abnormal gut motility, not drinking enough fluids and not including enough fibre in the diet.
Certain medications affect gut motility and tend to slow down the movement of content down the tube. (Blood pressure drugs, anti-histamines, anti-depressants, Narcotic pain killers like Codeine)

Soft, Sticky, Putty like, Pasty or Clay like Stool
this may be due to excessive amount of soluble fibre in the diet or the presence of too much mucus. Mucus in Faeces originates from the lining of the gastrointestinal tract.
Too much mucus may indicate inflammation of the lining of the Colon and Rectum.
Soluble fibre is food for the resident bacteria in the colon, but it also has the capacity of aiding the retention of water within the faecal mass which may cause formation of abnormal stool.
This type of stool may adhere to the inside lining of the colon, rectum and anus and stimulate the urge to open the bowel repeatedly and lead to Straining to generate pressures in order to dislodge the faeces adhering to the Anal or Rectal passage.
Excessive gas may also be produced and occasionally this can also result in accidental incontinence and soiling due to leakage.
All vegetables make stool softer, but too much Cabbage, Brussels sprouts, Onions, Beans and Broccoli appear to contribute to this problem.
Bile salts in the stool contribute to the brown colour of normal stool. Any obstruction of the flow of bile from the liver and gall bladder may produce Clay coloured stools. This can be due to Hepatitis, Gallbladder disorders or malabsorption disorders.
Other causes are too much caffeine, Alcohol (Beer, Guinness), sweeteners such as Lactose and certain spices.
Sticky stools due to excessive amounts of mucus may indicate inflammation in the gastrointestinal tract and may be due to infections due to parasites (Amoebiasis, Giardiasis) or inflammatory bowel disease. Blood may also be present in these circumstances.

Black, Tarry, foul smelling Stools
the black colour can indicate the presence of blood in the stool. Bloody stools are often a sign of an injury in the digestive tract.
The term "melena" is often used to describe black, tarry, and foul smelling stools.
Blood in the stool may come from anywhere along your digestive tract, from mouth to the anus.
The Black colour indicates that the blood has been processed by enzymes and is coming from the upper part of the gastrointestinal tract. This includes the Oesophagus, Stomach, and the first part of the small intestine.
Blood will look like tar after it has been exposed to the body's digestive juices as it passes through the intestines.
Certain medications that contain Iron or Bismuth may also produce black stools.
This type of stool requires investigation and should be reported to your Doctor without delay.

Bright Red or Bloody Stools
certain foods such as Beet root and Tomatoes cause stools to be reddish but the major cause is due to the presence of blood.
A streak of red in the stool together with red on the toilet tissue or toilet pan is obviously blood and means bleeding along the gastrointestinal tract.
Fresh blood normally suggests blood from Haemorrhoids or Anal fissure but should be reported to your Doctor if it persists so that other possible causes can be investigated.

Maroon stool
certain foods, such as Beetroot may contribute to this type of stool.
Intestinal bleeding (from the middle intestine or proximal colon) due to Ulcers, Tumours, bleeding associated with Crohn's disease Ulcerative Colitis and Diverticulitis may lead to this type of stool.

Floating Stool
Normal healthy stool should sink to the bottom of the toilet pan. However, stool often contains a large amount gas from the process of bacterial fermentation and may float on top of the water in the toilet pan. This does not indicate any disease processes.
The presence of fat in the stool causes it to float and may indicate malabsorption of fat in the intestines (E.g. in Celiac disease), however, this type can be distinguished by the pale yellow colour and greasy texture with foul smell.
The weight loss medications Xenical (and Alli) prevent the absorption of fats and cause this type of stool as a side effect.

 

How to heal and prevent Bowel disorders

Diet is not about what you should NOT eat, it’s about what you should include in the diet that matters.
As long as your diet includes the correct balance of plant foods containing soluble fibre, insoluble fibre and resistant starch your colon will produce the perfectly formed stool. The important next step is to evacuate this stool without straining so that the body does not suffer from the pressures created each time the bowel is emptied.

In order to heal and prevent bowel disorders you need to make lifestyle changes that last the rest of your life time.

1. Include more fluids and plant food containing soluble fibre, insoluble fibre and resistant starch in the diet so that the perfectly formed stool will be made in the colon and beneficial bacteria will flourish and eliminate disease causing bacteria and fungi.

2. Evacuate the perfectly formed stool by adopting the squat posture to eliminate the need to strain during bowel movements.

It is not possible or safe to squat on the modern raised toilet seat installed in all western homes and it is impossible to squat for any length of time if you have not done this from childhood onwards. This makes the use of any raised platforms impossible to adapt to.

The SquattLooStool is designed to allow you to adopt the squat posture while seated comfortably on your raised toilet seat.
The single best and easiest lifestyle change you will ever make, leading to a healthier body.