It’s not a topic people like to talk about, but it’s still important for health and well-being: bowel movements. But a close look at the big business is worthwhile. Because even if changes in the color and consistency of the stool are often caused by diet and are completely harmless, they can sometimes provide clues to diseases during bowel movements. What does a light or clay-colored bowel movement mean? What do soft stools say about health? We have compiled an overview of the possible significance of the color, consistency and odor of the stool and explain how stool changes can occur.
What is stool made of?
Stool is formed when food is digested in the intestines. It consists mainly of undigested food components such as fiber and water in variable proportions. In addition, in healthy people, stool contains bacteria of the normal intestinal flora, rejected cells of the intestinal mucosa, digestive secretions and mucus. Bowel movements: 13 questions and answers
Bowel movements: how often is normal?
The frequency of bowel movements varies from person to person. Stool frequencies ranging from three times a day to three times a week are considered normal. If defecation occurs less frequently than three times a week, it is called constipation. Frequent bowel movements, on the other hand, do not necessarily have disease value: only if soft, unformed stools are passed more than three times a day is diarrhea present by definition.
Stool quantity dependent on diet
The normal daily amount of stool is 100 to 200 grams per day. With a low-fiber diet or reduced food intake such as fasting, the amount is less; with a high fiber intake – such as vegetarians – stool amounts of up to 1,000 grams can be normal. However, an increased stool quantity with a normal diet can also indicate a digestive disorder, for example in the case of a disease of the pancreas. A warning sign here is also if the stool is noticeably smelly and at the same time greasy shiny.
Why does stool have different colors?
The characteristic medium-brown color of the stool is caused by a degradation product of the red blood pigment hemoglobin: when red blood cells are degraded in the spleen, the bile pigment bilirubin is produced, which passes with the bile into the intestine and colors the stool brown there. Thus, it is understandable that diseases of the bile ducts can cause a change in stool color. However, various foods, medications, infections, metabolic disorders or bleeding can also affect the color of the stool.
What does color tell us about bowel movements?
Normally, stool should be light brown to dark brown in color. Color changes can be diet-related, but in some cases indicate disease. The following overview can help you correctly classify different stool discolorations:
- Deep brown/black: A very dark to black stool may indicate bleeding in the stomach or small intestine and is then called tarry stool (melena). The color is caused by the breakdown of blood in contact with stomach acid or intestinal bacteria. However, certain foods such as beet, spinach, blueberries and dark chocolate, as well as charcoal tablets and iron supplements can also cause blackening of the stool.
- Gray/clay/cream colored: If the stool is strikingly light, a disease of the bile ducts or liver may be behind it. Other warning symptoms are nausea, vomiting, upper abdominal pain or colic and brown urine. In any case, light stools should be clarified by a doctor.
- White: The X-ray contrast agent barium sulfate (“barium swallow”) is used for radiological imaging of the gastrointestinal tract. It is excreted undigested again and thereby leads to a white coloration of the stool.
- Ocher: ocher-colored stool may occur in abnormal fat excretion (steatorrhea). Typically, this so-called fatty stool is voluminous, greasy shiny and malodorous. The cause is usually a disorder of fat digestion or fat absorption in the intestine, which can occur in various diseases of the digestive system and metabolism. A medical clarification of fatty stools is therefore necessary.
- Green: Greenish stools can occur when eating foods containing chlorophyll, such as spinach, kale or lettuce. Green diarrhea, on the other hand, is an indication of intestinal infection.
- Yellow: Foods such as carrots, squash, or eggs may cause the stool to turn yellow. However, in conjunction with diarrhea, a yellow stool color indicates an intestinal infection.
- Red: A uniform reddish color of the stool can be caused by the consumption of beet, cranberries or red food coloring. However, if it is admixed blood, a visit to the doctor is essential.
What should be the consistency of stool?
Normally, stool is a soft but formed mass that is easy to excrete. Variations are often due to diet and behavior: for example, a low-fiber diet, low drinking and lack of exercise can promote hard stools and constipation. Constipation, in turn, leads to hardened stools, as water is increasingly reabsorbed from the stool when it remains in the colon for a longer period of time.
Bristol Stool Shape Scale: Classification of stool consistency
A stool shape and consistency classification chart was created at the University of Bristol in England in 1997. Called the Bristol Stool Shape Scale, it includes seven stool types:
- Type 1: hard globules, difficult to excrete.
- Type 2: firm, sausage-shaped lumps.
- Type 3: sausage-like, with cracked surface.
- Type 4: sausage-like, with smooth surface
- Type 5: smooth, soft lumps, easy to excrete.
- Type 6: mushy with soft clots.
- Type 7: thin, watery, without solid components.
Types 3 and 4 are considered “ideal stools”, but type 5 can also occur in healthy people. Type 1 and 2 are often associated with constipation, whereas type 6 and 7 occur with diarrhea. If the stool is pencil-shaped or ribbon-noodle shaped, this may indicate strictures in the bowel. Possible causes may include adhesions, intestinal polyps and, in rare cases, colon cancer. Therefore, if you have thinly formed stool, you should see a doctor as soon as possible.
Blood in the stool? Be sure to see a doctor!
Blood in the stool is an alarm sign and should always be clarified by a doctor. Although the cause is harmless in many cases, serious diseases can also be behind bloody stool. Possible causes of blood in the stool include:
- Anal fissure: In the case of tears at the anus, which can occur, for example, with chronic constipation, bright red blood is usually found on the toilet paper or deposited on the stool. Typical are pain and burning during defecation.
- Hemorrhoids: If the stool burns and the anus itches after defecation, this may indicate hemorrhoidal disease. Enlarged hemorrhoids are also often manifested by bright red bleeding during bowel movements. Pain, on the other hand, is rather atypical.
- Intestinal infection: various diarrheal pathogens such as Salmonella, Shigella, Campylobacter jejuni, amoebae or EHEC can lead to bloody diarrhea.
- Intestinal inflammation: If there is inflammation in the intestines, such as ulcerative colitis, blood in the stool or bloody diarrhea may occur.
- Diverticula: Protrusions of the intestinal mucosa (diverticula) are harmless in themselves, but can become inflamed or bleed, causing blood in the stool.
- Tumors in the intestine: benign (polyps) or malignant (colon cancer) growths in the intestine or anus can cause bloody stool.
What to do about stool changes?
If you notice changes in bowel movements, you should first consider whether this could be due to diet. Unfamiliar foods and a different daily rhythm – on vacation, for example – can change the appearance, odor, consistency and frequency of bowel movements. On the other hand, persistent changes unrelated to diet, as well as sudden fecal incontinence, are reasons to see a doctor. After a thorough interview and physical examination, the doctor will usually perform a palpation of the rectum. A blood test and a stool sample may provide evidence of inflammation, infection or bleeding. The doctor will then decide whether a colonoscopy is necessary for further clarification.
Bowel movements in the newborn infant
The first stool in a baby is called infantile sputum (meconium) and is typically green to gray in color. Usually, the first bowel movement after birth occurs within the first 48 hours. Usually, the baby forms food stool by the second to fourth day of life – mixed with meconium, it is called transitional stool.The subsequent pure breast milk stool is usually yellow to orange and has a creamy consistency. 11 flatulent foods
