WHAT YOUR POO SAYS ABOUT YOUR HEALTH
Whether it’s white, yellow, red, or green, what you find in the toilet each day can go a long way to alerting you about your state of health.
Since the Bristol Stool Chart – the gold-standard assessment of a perfect poo – was first introduced 25 years ago, gut specialists and gastroenterologists have learnt a wealth of information about our bowel habits and what they might signify.
From stomach ulcers to signs of cancer, a plethora of different diseases can manifest in consistent changes in your poo. “Obviously we can’t see inside our guts on a normal basis,” says Dr Cormac Magee, a consultant gastroenterologist at University College London Hospitals NHS Foundation Trust. “It’s not like the skin where you can see what’s going on, so your stools give us a clue as to what’s going on in our intestines and other internal organs.”
But before we turn into a nation of hypochondriacs, obsessively tracking our daily bowel movements, it’s important to know what is normal, and when you should consider seeing a doctor.
What is normal?
According to Julie Thompson, a trained dietician who now works as information manager for the charity Guts UK, normal poo should be “smooth, shaped like a sausage and chestnut brown in colour”.
However, both colour and consistency can vary greatly, depending on our mood, working habits, sleep and of course what we’ve been putting in our body. According to the Bristol Stool Chart, poo can either be hard and firm while retaining a particular shape, soft and formed, loose like porridge or thick milkshake, or liquid and runny like water. Various case studies have also indicated that the colour of stools can also vary greatly, shifting from a standard brown to green, red, yellow and even orange.
None of these things is necessarily an immediate cause for alarm, but Dr Magee says that the key thing to watch out for is a consistent change in your bowel habits which persists for several weeks.
“Your bowel movements vary day to day depending on what we’ve eaten, what we’ve done activity wise, and factors like stress,” he says. “If you’re experiencing sudden changes towards constipation or diarrhoea for a day or two and then it goes back to normal, that’s less concerning. But if it’s happening for several weeks, that’d be a reason to speak to your doctor and get checked out.”
So from colour to consistency, what do these different changes mean?
Runny and liquid
According to Thompson, this signifies that the gut contents are travelling too quickly through the bowel. While this is a common reaction to an infection, some medicines or food intolerances, as it is the body’s inbuilt mechanism of trying to flush away toxins as quickly as possible, it can also be a symptom of chronic problems such as irritable bowel syndrome (IBS) or inflammatory bowel disease.
“Diarrhoea can be described as anywhere between soft blobs of poo with clear cut edges to entirely watery liquid,” she says. “Diarrhoea is a symptom of poor gut health and there could be a wide range of different causes from a gut infection or food poisoning, which is relatively short term, to a digestive disease and this is usually chronic.”
Yellow stools
“People can get yellow stools for various reasons, you can sometimes get it in the context of viral infections, and some types of food poisoning,” says Dr Magee.
This can also happen for relatively harmless reasons, such as consuming a lot of foods which contain a pigment called beta-carotene, found in carrots, sweet potatoes and some leafy greens.
However, research suggests that one of the common causes of stools appearing yellow or greasy is that they contain too much of a yellow pigment called bilirubin. While bilirubin is naturally present in poo, excessive amounts of it can indicate problems with the liver, pancreas and gallbladder, or conditions such as coeliac disease, where consuming gluten causes the body to attack its own tissues.
If yellow stools are also accompanied by stomach pain, fatigue, indigestion and constipation, this could indicate wider issues.
Green stools
This is very normal to see in newborn babies and is usually the result of ingredients within formula milk or green foods being passed on to the infant via the mother’s breast milk.
In adults, it can be the result of either chemicals within processed food or drinks which give them a green hue or eating a lot of green vegetables. However, it can also represent the impact of antibiotics on the gut, a persistent gut infection, or more concerning problems affecting the liver.
“Green poo can also be caused by a condition called bile acid diarrhoea,” says Thompson. “Bile is a substance made by the liver and it helps digest fats from food. Sometimes there is a problem with the circulation of bile in the body, so bile then stays in the stools without being reabsorbed and hence discolours the poo. This can occur if someone has liver or gallbladder disease or if the person has had bowel surgery or disorders of the small bowel.”
Hard and lumpy
The Bristol stool chart describes stools as varying from watery at one extreme to separate hard lumps, almost like nuts.
Magee says that this can often be accompanied by constipation, which can be very common for some people. However, if it happens suddenly and then persists for a period of time, it can be a sign of IBS developing or something more sinister.
“The thing to say is that everyone has their own different bowel habit,” he says. “Some people might go a few times a day, and for others it might be once a day. It’s more the sudden changes that we look for. So if someone suddenly experiences constipation, you might be worried about something causing a blockage within the bowel such as cancer.”
Red stools
Our poo is quite literally coloured by what we eat, so consuming beetroot or red dyes in products like strawberry jam, red velvet cake, canned cherries or strawberry liquorice can lead to red poo.
However, sometimes this can reflect the presence of fresh blood, a far more concerning sign. “It could also be a warning of a digestive disease,” says Thompson. “It should be reported to your GP if it is not caused by eating something obvious. Digestive diseases could include inflammatory bowel disease, bleeding due to polyps in the bowel, bowel cancer, diverticular disease, or possibly severe food poisoning. These conditions cause blood in poo, but blood coating the surface of poo could be due to piles.”
White stools
Just as with green stools, pale-coloured stools tend to signify a problem in the way in which bile is being processed by the body, the substance which normally gives colour to stools as it goes through the gastrointestinal tract.
Dr Magee says that this can often signify an obstruction, sometimes gallstones in the gallbladder or perhaps a pancreatic tumour which is affecting the flow of bile. Sometimes this means that pale stools are accompanied by very dark urine, because bile is ending up in urine rather than progressing into the bowel.
“If you pancreas is not working properly and not producing the normal enzymes, you can also end up with very fatty, oily stools as well, because you’re not breaking down the fat in the gut, and that can also sometimes cause a change of colour to the stool,” he explains. “So this signifies there’s a problem, but it’s not necessarily a cancer.”
When should you be concerned?
Magee recommends consulting your doctor if you’re seeing a noticeable change in your bowel habits over a period of time which isn’t going away, or a sudden, unusual change.
One of the most concerning signs of all is stools which appear black and tarry because this indicates bleeding in the upper digestive tract even in the stomach or small intestine, something which requires urgent medical attention.
“If you have very black tarry stools, or pale stools and dark urine, those are definitely things to get checked out,” he says. “If there’s lots of black tar in the stool, it’s probably a very urgent A&E type thing because that could be a sign of bleeding.”
For more information, you can check out the Poo-Torial provided by Guts UK
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