What is your gut telling you?
Iam putting my apologies out there right now. If you are eating breakfast while reading this, I would suggest putting down the paper and revisiting it later. Funnily enough, poo talk doesn’t seem that appropriate at meal times.
A large number of patients I see each week are worried about their gut. This is fair enough, as there are myriad things that can cause it to malfunction – from food intolerances, to infection, tumours and inflammation. However, what strikes me is that many people don’t actually know how a normal gut behaves.
The gut’s role is to move food through the body, from the mouth to the anus, by means of peristalsis – a wave-like movement that pushes the food along. As food moves through the gut, nutrients salts and water are absorbed into our blood stream, leaving behind the debris or waste that forms a stool.
If our food moves too quickly or too slowly through the body, it can make you feel unwell, and lead to serious health issues.
When you are considering if you are having problems with your gut or not, the most important thing to know is what is normal for you – a good rule of thumb is that a change from your normal routine, especially if it is a change that persists for more than a few days, is potentially worrying and should be discussed with a doctor.
There is a huge spectrum of what constitutes normal when it comes to bowel movements. Anything from three loose-ish stools per day, to three more formed ones is in the spectrum of normal, and wouldn’t cause me to worry as long as this was a normal pattern.
So if you’re not sure whether you have a normal gut or not, here are some top things to look out for:
Regularity
Within the spectrum of three a day to three a week, work out your normal pattern. If there’s a sudden, sustained change, it may indicate an underlying problem in your gut. Too frequent might mean you are not absorbing enough nutrients from your gut; too seldom might indicate constipation or obstruction. Diet can have a huge impact, so focus on a balanced, healthy diet with lots of water and fibre, and see if your bowel routine improves.
Consistency
Again, any change is the important thing to note. Stools that suddenly become runny or watery might be due to infection, inflammation, or intolerances. Stools that become very hard or dry are usually because of constipation, dehydration, or certain medications. Some people regularly find the consistency of their stool varies between the two; especially common in women because of hormone changes through the menstrual cycle, but can also indicate conditions such as irritable bowel syndrome.
Shape
Anything from a soft blob, to a firm sausage or snake can be normal. What isn’t normal is persistently watery stools, or very hard ‘‘pebbles’’ that are difficult to pass. The other shape to be aware of is a narrow stool, a bit like a pencil. This can indicate an obstruction in the lower gut, such as a tumour, and needs urgent assessment.
Pain
If there is pain associated with passing a bowel motion, that is not normal. You should be able to pass a stool with the minimum amount of straining, much like you would pass wind or urine. Pain can again indicate all sorts of things, however, should be discussed with your doctor.
Smell Colour
Medium to light brown is good! Too pale can indicate jaundice, or malabsorption problems. Very dark or black stools might be due to bleeding higher up the gastrointestinal tract – cancer until proven otherwise. Contrary to popular belief, noone’s stool smells like roses. But if your bowel motion suddenly starts to smell way worse than it normally would, it could be a clue to an underlying condition such as infection, malabsorption, Coeliac or Crohn’s disease.
Mucous or blood
The presence of mucous or blood is never normal, especially if it is mixed through the stool, rather than just on the toilet paper. Inflammation, infection or cancer can present this way, so don’t delay getting a medical opinion. Any change in bowel habit, even subtle, should prompt a visit to your doctor. Some basic tests may be all that is needed to rule out an underlying serious condition, and set your mind at ease. Cathy Stephenson is a GP and medical forensic examiner.