There are fewer things as intrinsic to your body as pooping. After all, in your first weeks in the world, all you did was eat, sleep, breathe and poop. But has it always been an ideal experience? There are a number of factors that indicate whether your bowel movements are healthy, and if they aren’t, they could also be an indication of underlying health issues that need to be addressed.
Like your fingerprints, everyone’s bowels and how they function are unique to them, but it’s the subtle (or not so subtle) changes that could raise a red flag.
We spoke to Dr. Sapna Makhija, gastroenterologist and co-director of the GI Health Centre in Burlington, Ont., to get the dirt on healthy poops and how to know when your health could be circling the tank.
“There’s no right or wrong answer to that,” Makhija says. “For some people, it’s perfectly normal to go one to three times a day, for others, they may go three times a week. It depends on the individual.”
However, she says if there’s a persistent change in your bowel movements that lasts from four to six weeks, you need to address it with a physician.
“If you typically go every day and then for six weeks, you’re only going once or twice a week, you need to see a doctor. Some people have lazy bowels, but if you’re accustomed to going three times a week and you feel miserable on the days you don’t go, you have to figure out why it’s happening.”
In 1997, doctors from Bristol Royal Infirmary in England created a diagnostic chart based on a large-scale study that examined the bowel habits of 2,000 men and women. Called the Bristol Stool Scale, it’s used as the standard guideline for the different types of feces, ranging from constipation to diarrhea, as well as a tool to evaluate various bowel diseases.
It’s broken down in seven categories: small hard lumps, a lumpy sausage-like shape, sausage-like with cracks on the surface, smooth and snake-like, soft blobs with clear-cut edges, fluffy mushy pieces, and liquid or watery.
“I always ask my patients about the form, consistency and colour of their stool, and anywhere from three to four, and at times even five [on the Bristol scale] is normal,” Makhija says. “Anything outside of that is either constipation or diarrhea.”
Typically, feces is brown in colour because it contains bilirubin, which is a pigment byproduct of the breakdown of red blood cells in the body. But other colours can be cause for alarm.
“If your poop is pale or clay-coloured, it could be an indication of a bile duct obstruction, and if it’s black or dark red, that could be a sign of internal bleeding from your GI tract,” Makhija says.
In addition, yellow feces accompanied with fat droplets could be an indication of an underlying health issue like Celiac disease.
One colour that shouldn’t freak you out, however, is green.
“Green stool is not known to be anything concerning. It could be regular bile that’s being secreted into the colon, or sometimes people have faster colonic transit, which means the food they eat [like dark green vegetables] don’t get broken down fast enough before passing through.”
This tends to mimic the colour of your stool. The presence of bacteria is what contributes to the strong-smelling nature of poop, but sometimes an odd or particularly pungent smell could indicate something is amiss.
“If the [uncharacteristically] bad smell is persistent, it could be an indication of malabsorption, and could be a sign of Celiac disease and certain pancreatic issues,” Makhija says.
But the biggest concern should be if your black, tarry stool is accompanied by a particularly foul odour, which can indicate internal bleeding.
Once again, this is dependent on the individual, how often they go and what they’ve had to eat. But one thing Makhija stresses with her patients is to do the deed and get out.
“We don’t recommend sitting for an extended period of time,” she says. “Go when you feel the urge but don’t sit there for too long, otherwise you’re consistently straining and that’s how you get hemorrhoids. Just do your business and get out.”
Any drastic changes that occur consistently over the course of four to six weeks warrant a visit to your doctor.
“Also, if there’s visible blood or fat in the stools, if you’re repetitively waking up in the middle of the night to have a bowel movement, or are experiencing unintentional weight loss.”
Makhija also says to keep an eye for a change in form. If you normally produce sausage-shaped stools and suddenly they’re taking a long, thin form, that could be an indication that there’s an obstruction in your colon.
The most concerning issue with constipation is colon cancer, she says. Although this could also be a result of metabolic changes like hypothyroidism.
With diarrhea, health concerns include infection, inflammatory disease and malabsorption.
“Both extremes require further investigation to see what the causes are.”
We know that adequate fibre intake is the answer to healthy bowel movements, but that doesn’t seem to inspire many North Americans to alter their diet.
“The majority of the population does not include enough fibre when it comes down to the types of foods they eat,” says Andrea Falcone, registered dietitian and certified fitness professional in Toronto.
The recommended daily intake of fibre for adults is between 25 and 38 grams. There are two types of fibre to include in your diet: insoluble and soluble. The former helps form your stool, as well as lower cholesterol and control blood glucose levels, while the latter helps to soften it.
“One thing people don’t connect with is the fact that fibre is great, but if you have too much of it and you don’t drink enough water, you’re not doing yourself any favours because it won’t keep you regular,” Falcone says.
To get insoluble fibre, eat lots of fruits and vegetables, whole grains and wheat bran, while soluble fibre can be found in the skin of fruit, oats, barley, psyllium husk, beans, lentils and some vegetables.
“I don’t focus too much on numbers with my clients, but I encourage them to look at their meals and see where they can include fibre,” she says. “At breakfast, do you have a fruit or a whole grain source? Have you included some kind of vegetable or whole grain at lunch? With dinner, have you incorporated at least two choices of vegetables?”
She suggests making simple and easy-to-incorporate changes to your diet, like adding a teaspoon of psyllium husk or ground flaxseed to your morning smoothie, snacking on an apple or a pear with almonds, and including a few handfuls of spinach to your dinner.
“The thing is you don’t want to add too much fibre all at once because it can have the opposite effect,” she says.
She also points to physical activity as an important component to staying healthy and regular.
“Physical activity has a big impact,” she says. “If we’re not moving, nothing will move [internally] either.”
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