Yeah, we're going there. We're digging deep—going where you'd probably rather not think about.
But you know what? Go ahead; take a peek in your toilet. It’s a gold mine of knowledge about your health, status of your nutrition, and more, says Anish Sheth, a gastroenterologist and author of What’s Your Poo Telling You?
Now, for everything you need to know about your poo, keep reading.
“An empty toilet bowl is the worst case scenario, but, aside from that, stool that lacks cohesion, has small particulates, and is eliminated in multiple, small pieces is a classic sign of constipation,” Sheth says. If it’s harder to pass (drier), and it happens occasionally, it’s likely you’re lacking fiber and water. Try adding these super fiber foods in your diet; and if you're having a hard time drinking enough water, try these tasty alternatives to tap.
“If it’s a more long-standing issue, it could also be what we call slow transit constipation, something where your colon is moving things downstream much more slowly,” Sheth adds.
Prescription medication can also be influencing your irregularity. The two main culprits are blood pressure and pain meds, specifically those in the narcotic class. They also slow down the movement of your GI tract, making your bowel movements irregular and more difficult to pass.
“The looser, more liquid consistency stools tend to be diarrhea, which actually refers to both the consistency and frequency,” Sheth says. It can vary in appearance and color, depending on its cause. Pick up some Imodium—stat. And stay hydrated! Taking a probiotic like Culturelle might help with occasional diarrhea, too.
“There are exceptions, but for the most part greenish stool tends to signify an infectious diarrhea, which is either a bacteria, parasite, or a virus,” Sheth says. Head to your doc.
“If you have diarrhea that’s very dark—specifically black—that’s very frequent it can indicate blood loss,” Sheth says. One of the causes can be a peptic ulcer higher up in your stomach. Head to your doc or a walk-in clinic right away.
How’s this for a visual? “You can actually have an oily, yellowish, sort of greasy-appearing diarrhea which can be a sign of malabsorption,” Sheth says. If you have a hard time absorbing or digesting fats, your poop will appear glistening. Talk to your physician; malabsorption can be caused by conditions like celiac disease, Crohn’s disease, lactose intolerance, and/or intestinal damage.
“Dark blood is usually from the stomach, typically from an ulcer,” Sheth says. “Then if you have red blood coming out, that’s usually from lower down in your GI tract,” he explains. Acute conditions like hemorrhoids would be the most common, sort of benign cause; but things like polyps and conditions like colon cancer can cause those symptoms as well, he notes. Chronic conditions like ulcerative colitis, can also cause you to have bloody diarrhea from inflammation in your colon. Any time you see blood in your toilet, talk to your doctor.
"Artificial dyes and some vitamin supplements can give crazy colors to your stool, but those are not usually signs of medical issues," Sheth says.
Don’t worry. “Any kind of variation on a shade of brown is normal.” Color will vary depending on what you eat.
“Floating mostly reflects the amount of gas in your stool, so it’s not necessarily a bad thing,” Sheth says. “There are certain times when you’re going to have a couple bowls of chili or a burrito, and you’re going to have more gas in your GI tract.” For the next day or two, you may have floating stool.
Also, floaters can indicate you're not absorbing nutrients, like fat. If there's too much in your diet or your body is having a difficult time absorbing a normal amount, it'll make your poop float
If you’re digesting your food properly and your intestines aren’t loaded with gas, your poop will sink; it won’t have that buoyancy. “It’s just going to settle at the bottom of the toilet bowl.”
There’s a "normal" range based on a study from a couple decades ago, which is still quoted today. "Three times a day is on the higher frequency and once every three days is the minimum amount you should be going," Sheth says. Pay attention to changes. Both of these patterns are normal so long as when you go to the bathroom it's sort of effortless, you feel fine in between, and there’s no abdominal discomfort. These factors determine what’s normal. "But for somebody who’s been going once very day and now all of a sudden goes three times a day out of the blue, that’s sometimes a sign something's wrong."
“If it’s a one-time occasion that you notice very thin-caliber stool that’s most likely related to a lack of fiber,” Sheth says. “The theory here is that you have a small volume, and you’re really straining to expel that bowel movement as opposed to just relaxing.” When you strain and try to force it out, you tighten up your rectal sphincter muscles. In turn, the opening through which the stool comes out is very small and so you end up with a very thin, small amount of poop. “When it’s persistent and progressive, which means it’s been going on for weeks, or even months, and the stool is gradually becoming more narrow, that’s when you get concerned about rectal cancer or something that’s blocking the bottom portion of your intestines.”
*Don’t freak just yet: The important takeaway is it’s only concerning if it gets progressively worse and persists for weeks.
If your poop is putrid, your body probably isn’t digesting food properly. “Let’s say you have lactose intolerance or celiac disease where you can’t process gluten,” Sheth says. “You have undigested food making its way into your colon, which starts a process called fermentation." That bacteria in your colon takes all this food and begins to ferment it (a process that turns sugar into acid, gas, or alcohol; in this case it's gas). You get a lot of flatulence and foul-smelling stool. Talk to a dietician to see if you have any food intolerances or sensitivities.
“Some of it is based on diet; but if your digestion is healthy and there’s normal processing of what you’re eating, most of the digestion and the processes will take place in your small intestine so you’ll just have some residual left in your colon,” Sheth says. When your digestion is poor and food is left in the colon for a while, bacteria starts to get at it and fermentation begins (as we noted earlier). As for the diet, more veggies will make your poop stink less; more meat will make it worse.
If you don't have diarrhea, but feel you have to go with a sense of urgency that can't wait, it could be because of what you're doing or eating. "Exercise is a great stimulus for what we call GI tract motility, meaning the movement of the muscular portion of your intestines is stimulated by moving around and exercising, so it keep things moving downstream in a timely fashion," Sheth says. So, it's perfectly normal to have to run to the bathroom in the middle of your run.
If you always have to use the bathroom as soon as you get in to work, like clockwork, it's likely because of your morning coffee. "There is something called chlorogenic acid," Sheth says. "It’s actually the active compound in coffee that causes the stimulation of your GI tract. Now, caffeine by itself does this a bit, but the reason why coffee is such a big stimulus is because of this chlorogenic compound that keeps the normal wave-like motion of the GI tract moving downstream."
And if you practically wake up needing to use the bathroom after a night out, don't sweat it; it's common.
"Alcohol itself, rather ethanol, is a stimulant for the GI tract; but then there’s also this theory—I’m not sure how much it's been proven—depending on what you drink can have an impact," Sheth says. "When people drink a lot of malt liquor, there’s classically a lot of diarrhea," Sheth says. "It’s not necessarily just the ethanol content, but also the high load of carbohydrates, which make it downstream into the colon where fermentation takes place." So you're bound to have gas and loose, frequent stools specifically with alcohol that's higher in carbs. "It’s less common with a glass of wine," Sheth adds.
There are many factors, but this is what you want: “It should be effortlessly expelled in a single bolus, which is smooth and soft,” Sheth explains. “It should have very little aroma, obviously no blood, and be some shade of brown. It should ideally sink to the bottom of your toilet bowl. After the bowel movement, you should feel like you’ve completely evacuated. If you evacuate fully, in a single piece a cohesive stool, you tend to feel like the rectum and the bottom portion of your colon is empty and that tends to be a sign of a healthy bowel movement.”
With constipation or diarrhea, you don’t have that sense of emptiness—like you got everything out of you and you just cleared your entire GI tract. “People with diarrhea sometimes feel like there’s still more coming out, people with constipation feel like there’s still stuff left behind,” he further explains.