4 things your poop is trying to tell you

Bowel habits and the appearance of stool (the medical term for poop) vary dramatically from person to person. Much like the differences in our appearance, everyone's bowel habits are unique to their body. Diet, fluid intake, exercise and the makeup of your body all help to regulate what you perceive as normal when you go to the bathroom.

What is normal varies. Some people have two to three bowel movements every day while others consistently use the restroom once every three days. Some people tend to produce softer, semi-formed stools while others tend to create firmer stools. In the absence of other symptoms, you should not be alarmed if you have a different pattern than others.

How to recognize digestive changes

It is more important to recognize changes in your own bowel habits from your established normal. Often these changes are simply related to diet, exercise or fluid intake, but occasionally digestive symptoms may be due to a more concerning cause, which means that you should speak with your doctor. Changes in bowel habits are one of the leading symptoms of colon cancer.

I get many questions regarding what a normal stool should look like and unfortunately, the answer is never straightforward. As a gastroenterologist, much of my role in evaluating a person is determining whether it is a fluctuating change related to daily environmental factors or a symptom of a health condition.

While I encourage everyone to discuss any concerns they have regarding bowel habit changes with their primary care physician, here are some changes that people can look out for and what they mean:

1. Change in consistency

Stool caliber refers to the size, shape and consistency of your bowel movements. Stool consistency can vary from straight water to hard and pebble-like. People may have difficulty describing it, so often we use a scoring system called the Bristol Stool scale to better understand what is happening.

The seven categories on the Bristol Stool Scale are:

• Type 1: Separate hard lumps, like nuts (difficult to pass)
• Type 2: Sausage-shaped but lumpy
• Type 3: Like a sausage but with cracks on its surface
• Type 4: Like a sausage, smooth and soft
• Type 5: Soft blobs with clear-cut edges (easy to pass)
• Type 6: Mushy pieces with ragged edges
• Type 7: Entirely liquid, watery with no solid pieces (severe diarrhea)

A change from formed stool to watery stool may indicate:

• Certain foods aren’t being absorbed
• An intentional or accidental ingestion of laxatives
• An underlying bowel inflammation
• An infection
• A partial obstruction, leading to liquid stool

A change from looser or soft stools to harder stools may indicate:

• Bowel motility problems, when the intestines don’t contract and move contents along the digestive tract efficiently
• A possible obstruction, including cancer

A decrease in stool caliber (i.e. pencil-thin stools) may suggest a possible obstruction in your bowels, which will need further evaluation.

2. Change in color

People frequently are concerned about green stools, but generally this is just a product of whatever they may have recently eaten and is nothing to be worried about.

Colors that are concerning include:

• Black, tarry stool suggests possible gastrointestinal bleeding. But the use of over-the-counter medications like Pepto Bismol or iron supplements may make stool dark or black.
• Bright red stool may indicate bleeding from lower in the gastrointestinal tract—usually the anal canal or colon. This is commonly hemorrhoids but may be a sign of cancer, so further evaluation is needed.
• Ashy, pale or clay-colored poop may suggest obstruction of the bile duct, as passage of bile into the intestines is responsible for the brown appearance of stool.
• Greasy-appearing stool, which looks like olive oil floating on the surface of the water, implies your body isn’t absorbing fat correctly. This suggests either a pancreatic-related condition or small bowel inflammation.

3. Constipation

Constipation is extremely common and one of the most frequent causes is not drinking enough water. The colon is designed to re-absorb water from the food we eat and will create hard stool to prevent dehydration. Generally increasing your water intake (not soda or other drinks) to 2 liters per day resolves many constipation issues.

Beyond fluid, increasing dietary fiber to at least 25 to 30 grams per day—either through foods or supplements—may help constipation. I often recommend the Mediterranean diet as it tends to contain a good mixture of low carbohydrates and higher fiber. 

For people with ongoing constipation problems that have not improved with lifestyle changes, I recommend a discussion with their primary care physician as they may require a gentle stool softener or laxative, as well as additional tests to get to the root of the problem.

Certain conditions such as kidney, liver or heart problems may require alteration of fluid intake, so make sure to discuss this with your doctor.

4. The presence of mucus

Mucus is naturally produced by the lining of the intestinal tract. It lubricates and protects the lining of your intestines, so it is normal to see it after you go to the bathroom. Occasionally, increases in stool mucus above the normal may reflect underlying colonic inflammation but this is typically seen with other changes, such as weight loss.

When should you speak to your doctor about your poop?

Learn what is normal for you and recognize concerning stool symptoms that need medical evaluation:

• Bright red blood or black tarry stool
• Worsening constipation, without any changes in your diet or fluid intake
• Decreased stool consistency
• Diarrhea, with more than three stools per day
• Change in bowel habits along with signs or symptoms of a health condition, such as unexplained weight loss, increased fatigue or anemia

When in doubt about your digestive health, make an appointment with your primary care provider to discuss your bowel health and determine if further tests are needed.