Over the years, I have observed how certain conditions such as stool problems provide greater degrees of angst as compared to others within my patient population. I’m sure many of you remember those sometimes uncomfortable conversations with family members regarding their bowel habits or lack thereof. These well-meaning family members like to share high levels of detail regarding their private bathroom experiences. People are intrigued with the color, consistency and smell of their feces. On rare occasions, my patients have even insisted they bring in a sample in some type of homemade container so that I may inspect their stools. I have even had patients report that they observed something “moving” in their stools.
However, discussing bowel habits with your provider should be a routine component of your preventative healthcare. Providers start asking about stool patterns beginning at the initial newborn visit. That first stool, known as the meconium plug, is important information because it assures the provider that the anus is open and unobstructed. The black tarry stool of infancy then progresses to a yellowish seedy material, which is consistent with a breastfed baby. Eventually this stool transitions to one that is more solid and therefore provides reassurance that the gastrointestinal (GI) tract is working properly.
Probably the most common stool abnormality noted in adults is constipation. These stools are hard, inconsistent and require straining. Some patients report only having stools every 8-10 days and have problems with bloating. For the majority of individuals, constipation is caused by a lack of dietary fiber. The recommended allowance of daily fiber is 25 grams. Foods high in fiber include beans, such as pinto and great northern and green leafy vegetables such as kale and collard greens. If after eating five to nine servings of fruits and vegetables daily and patients continue to experience constipation, I often recommend eating a bowl of Fiber One Cereal daily without milk.
On the other hand, if constipation remains unresolved, a more thorough evaluation is indicated. This may include getting some form of an imaging study of the abdomen such as an abdominal X ray or CT scan. These modalities can reveal if a patient has an obstruction, an inability of the stool to pass through a certain portion of the colon. If not corrected, obstructions could be life-threatening. However, these conditions are usually associated with pain, nausea and vomiting. Colonoscopies are also used to evaluate unresolved constipation. Stool softeners are sometimes used but laxatives are not to be used on a chronic basis and cause more harm than good over time by impairing the colon’s natural, symmetrical contraction and relaxation.
Just as hard stools are abnormal, so are those that are watery. Watery stools are usually caused by some type of viral infection of the gastrointestinal tract. Most people acquire such infections by the fecal-oral route: eating food that is contaminated or touching an object, such as a bathroom doorknob then eating with germ-laden hands. These GI infections are generally caused by the Norvirus species and can affect any age group. The infections are typically self-limited and will resolve within 24-72 hours. Dehydration can occur if diarrhea is severe.
Only rarely are diarrheal illnesses caused by bacteria but if diarrhea is severe or mixed with blood, then a more serious illness must be considered, like E. coli. Transmission is the same as with the viral conditions but symptoms may involve moderate to severe abdominal pain. Some of these patients will require intravenous hydration and supportive care in a hospital setting.
The last major category of concern as it relates to bowel health is the presence of blood in stools in the absence of an infection. The color of the blood can reveal whether the bleeding is coming from the upper or lower GI tract. If the blood is bright red, the lower colon is probably involved. Dark, maroon colored, or black stools usually indicate an upper bleed from the stomach or esophagus. Each of these conditions needs to be addressed by your primary care provider as soon as possible.
Proper colon health cannot be discussed without reiterating the importance of routine screening colonoscopies starting at age 50. These procedures are not painful and allow the doctor to directly inspect the inside of the colon with a flexible camera and remove any polyps present. Removing those polyps then decreases the likelihood of cancer. Research has also shown that people who eat diets rich in red meat and deficient in vegetables have an increased risk of developing colon cancer. Therefore, the best advice that I could give for maintaining optimum colon health is to eat five to nine servings of fruits and vegetables daily and decrease the amount of beef in your diet.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
