In the know about #2: Common questions about poop

George Blestel, MD

Colon and Rectal Surgery

Talking about #2 might be embarrassing, but your poop can reveal a lot about your health. How often you go, color, smell and shape – all these things can signal if something isn’t right. Colon and rectal surgeon George Blestel, MD, answered some common questions about poop and when it’s time to talk to your doctor.

What is a healthy poop shape?

The Bristol stool chart provides a handy visual that classifies human poop into seven types:

• Type 1: Separate hard lumps, like nuts (hard to pass – a sign of constipation)
• Type 2: Sausage shaped, but lumpy
• Type 3: Like a sausage but with cracks on the surface
• Type 4: Like a sausage, smooth and soft
• Type 5: Soft blobs with clear cut edges
• Type 6: Fluffy (mushy) pieces with ragged edges
• Type 7: Watery, no solid pieces (diarrhea)

Type four is the ideal, but anything between type three to type five is manageable. If you find yourself on the top or bottom end of the spectrum, talk to your doctor. They can give you advice about diet changes or medications that can get you back to an ideal type four.

Can color or smell indicate a health problem?

Most poop is brown, but it can change color from time to time depending on what you eat (think beets, lots of greens or cake with black frosting). Poop usually doesn’t smell great, but the time to be concerned is if it smells worse than usual.

“Foul smelling stool that is a noticeable change would be a sign for concern,” Dr. Blestel said. “Also, dark black tarry stools, anything with maroon or bright red blood or blood looking material within the stool are worrisome conditions.”

What causes diarrhea and constipation?

“The colon is essentially a storage depot for waste, so that we can eliminate our waste products on a regular basis and not just have continual bowel movements,” Dr. Blestel explained.

The way it does this is by introducing liquid into the colon. The lining of the colon then absorbs water to form the stool. Diarrhea is caused by a lack of water absorption, which makes the stool loose. Constipation is the opposite, caused by a lack of fluid intake.

“Medications are a common reason for this,” Dr. Blestel said. “They tend to slow the propulsion of things through the colon which then cause constipation. If you look at the package insert of almost any medication, a common side effect is either constipation or diarrhea. So, medications play a significant role.”

Diet is also a common reason for constipation, especially if you’re not taking in enough fiber.

“Things become constipated because the function of fiber is to hold water in and make the stool bulkier,” Dr. Blestel said. “Without fiber, the stool becomes firm and brick like, making it hard to pass.”

For someone who is often constipated, is it okay to regularly use laxatives?

Using laxatives for a short-term episode of constipation is reasonable, but if it’s persistent, it’s best to see a doctor.

“We would not recommend that somebody take laxatives on a regular basis without the guidance of their physician and a proper workup to rule out anything dangerous or life threatening,” Dr. Blestel said.

What is a colon cleanse and is it safe?

Some colon cleanses involve taking an herbal supplement type of concoction. Others involve using a tube-like device that’s inserted to the rectum so that water can be put into the colon and then flushed out.

There is no scientific research that says colon cleanses are helpful and doing either of these approaches is risky. For instance, shifting fluids can cause electrolyte abnormalities, especially in patients with heart and kidney disease. Using a device in the rectum could cause a tear or infection.

It’s best to stay away from these types of “fixes” and talk to your doctor for advice on colon health.

The bottom line when it comes to BMs

Keeping an eye on your bowel movements is a good thing. If you notice persistent changes in frequency or how your poop looks and smells, don’t ignore it or let embarrassment hold you back. Talk to your doctor.