So let’s talk about poo….what’s normal?

Anyone that has had a consultation with me will know that at some point I will ask about their poo. They will also know that I like all the ‘gory’ details: colour, size, shape, frequency, etc.  

It’s true that some people squirm with embarrassment or tell me that they never look (well really you should), but most seem happy to deal with my endless questions.

The reason why I always ask is that it never fails to amaze me how many people have no idea what a ‘normal’ bowel movement should be.  Some people live for years with a slightly wonky digestive system, for so long that whatever their bowel does is their ‘normal’, whether they don’t have a bowel movement for days and days, or go ten times in a day – neither of which are normal in my book.

Why does it matter?

The reason why I always ask, is that it is a good indicator not only of digestive health, but health overall.  At its simplest level pooping is a waste disposal system and like getting rid of any junk we want that to happen efficiently.

If this system is not working optimally I believe that it is important to understand the underlying causes contributing to the problem.  

If you are having many loose and explosive bowel movements in a day, I would think about whether there are any foods not agreeing with you; some type of dysbiosis in your large intestine (the wrong balance between the ‘good’ and the ‘bad’ bacteria), possibly you might have a small bowel overgrowth (overgrowth of bacteria in the small intestine), a problem with fat digestion, etc, etc.  There can be many factors underlying why this might be happening and Immodium is not the answer.

If you are constipated this can cause a lot of discomfort, pain and gas.  I would start by looking at your diet – particularly fibre and fluid intake.  However, it could also be a food that isn't agreeing with you.  A problem with digestive secretions (stomach acid / pancreatic enzymes).  A lack of exercise, imbalanced gut bacteria, a hormonal imbalance (such as underactive thyroid) a nutrient deficiency (magnesium is key for muscle function), high levels of stress, poor bathroom habits , etc.  In this case relying on laxatives is also not the answer.  Being chronically constipated should never just be ignored or lived with, it can lead to other problems like haemorrhoids, diverticulitis and is a risk factor in more serious conditions like bowel cancer.

What is a ‘normal’ stool?

My response to that is that is should be like a nice soft sausage; smooth and soft, easy to pass with no straining  and a mid brown colour.  Believe it or not there is a ‘poo chart’ called the Bristol Stool Chart, which provides a visual guide to the different types of stool.  Ideally yours should be something like 3, 4 or 5.

Stool chart.jpg

Some things to think about:

  • Frequency: experts tell us that there is no such thing as normal. Anything from 3 times a week to 3 times a day can be considered to be normal. What is maybe more important is how easy it is to have a bowel movement – with no pushing or straining or feeling like it hasn’t been quite complete. However, if I’m honest I really like people to have at least 1 bowel movement each day (with 2 or 3 being ok) and to be able to do this on a pretty consistent basis.

  • Colour: In general it should be a mid brown colour. Certain foods can cause a temporary change in colour (beets turn the stool red which can be a bit of a shock). However, on an ongoing basis the stool should not be light / tan / sand colour. Not green, orange or black. Each of which can be signs of other underlying problems.

  • Mucus: the presence of mucus in the stool can sometimes be a sign of inflammation so should not be ignored, particularly where there are any other digestive symptoms going on such as pain, bloating, etc

  • Undigested food: yes, we will all see certain foods like beetroot, sweetcorn and certain seeds in the stool – this is to be expected. However, if, on a regular basis, you can clearly identify what you had to eat at you last meal, this is not normal. It would imply that you are not breaking down the food that you are eating adequately.

  • Blood: always a red flag and not something to be ignored. Whilst it can be caused by issues like haemorrhoids it can also be a sign of a more serious problem. Do not be embarrassed and ignore it make sure that you get it checked out via your GP.

So please get any red flags like ongoing pain, mucus or blood checked by your doctor.  A nutritional therapy consultation can help you investigate dietary factors that might be contributing to your issues and if necessary functional laboratory testing can be used.