Stool, bowel movement, poo, number two. No matter what you call it, the fact of the matter is that it tells us an awful lot about the health of not only our bodies but also our minds. With that said, don't be alarmed when I ask you about your bowel habits in our next visit.
The following are the 8 most common questions I most typically ask a patient during an initial visit. What is your poo telling you?
1. Any changes in bowel movements?
This helps to identify any new problems that have emerged. In other words, it separates chronic from acute digestive issues.
2. How many bowel movements do you have a day/week?
Ideally, 1-3 bowel movements per day is considered normal. Some Naturopaths would say 3 bowel movements per day (one after each meal) is the best. I'll settle for no less than 1 BM per day with my patients. Less than that means that your body doesn't get the opportunity to remove waste and toxins from the body which can have effects on hormones, skin and energy (to name a few). Also, "sluggish" bowels can create uncomfortable bloating and gas. On the other hand, too many bowel movements could mean that the body isn't absorbing nutrients, you are suffering from hypochlorhydria (not enough stomach acid), or there is an infection. Food intolerances, sensitivities and allergies can contribute to constipation or diarrhea depending on the person.
3) How easy is it to pass?
Passing stool should be accomplished with ease- no straining or pain. Straining or pain likely indicates constipation (the stool is too hard). This is most indicative of a low fibre diet (ie. not enough fruits and veggies, but mostly veggies) or too little fluid intake. If these factors don't apply to you, ask yourself- What am I holding on to? There may be a mental/emotional component to your bowel habits.
4) Is it fully formed?
Stool that looks like a sausage or snake that is smooth and soft is the quintessential healthy poo. It does not break up upon flushing and does not leave a sticky residue in the bowel. Soft, fluffy or watery are all indicating that transit time through the intestines is too fast so that the water in the stool is not being reabsorbed. If lumpy or pellet-like, transit time through the intestines is too long so that too much water is reabsorbed.
5. Do you feel like you fully void?
Part of a "healthy" bowel movement is fully voiding. Do you ever feel like you could still go after having a BM? This means that the stool is likely not forming properly- either too loose or too hard.
6. What colour is it?
When I ask this question I often get a blank stare. "Well, brown of course" is the usual response. At this point most patient's think i'm nuts. However, stool can range in colour from black to brown to grey to green to red.
- Black- There could be bleeding happening higher up the digestive tract- usually a bleeding peptic ulcer. However, certain supplements or medications can have this effect, especially iron.
- Red- The person likely eats a lot of beets. But it could indicate bleeding lower down the digestive tract such as a hemorrhoid, fissure, cancer or IBD
- Grey- Likely an insufficiency of bile output from the gallbladder often seen in cholecystitis, gallstones, hepatitis or pancreatitis.
- Green stool- Green veggies aren't being digested properly. Digestive enzymes or digestive botanicals may be indicated.
- Brown- normal; the brown colour is created from bilirubin in bile
7. Is there any undigested food in it?
Corn being the only exception. When we eat, all food should be fully broken down by enzymes in our saliva, stomach and intestines. This ensures that we maximize the amount of nutrients we can absorb from these foods. Insufficient breakdown can lead to food sensitivities, allergies, nutrient deficiencies, fatigue/sluggishness, etc. Undigested food in the stool most likely indicates poor food hygiene (eating on the run, eating too much, eating while stressed, lack of mindful eating (more on that here: http://eatingmindfully.com/), lack of stomach acid production or a lack of digestive enzymes being produced from the pancreas.
8) Is there any mucus in your stool?
This is often seen in people suffering from IBS or in Crohn's and Colitis. It is also seen in gut dysbiosis (AKA: candida overgrowth). The presence of mucus suggests that the body is trying to repair inflammation in the intestinal tract.