Potty Talk: Understanding Feces, Stool, and Bowel Movements

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potty talkBowel movements are a regular and ideally effortless part of life, but we all know this isn’t always the case. Questions about one’s stool are common, whether they be worries about shape or color or just wanting to know why it smells so bad. Hopefully, this article can shed some light on the subject and also help you understand what’s normal, what’s uncommon, and what should be brought to your doctor’s attention.

What Is Stool?

Feces are roughly 75% water and 25% solid waste. The solids are a mixture of dead bacteria and cells, cholesterol, fat, inorganic substances, protein, bile, and indigestible food substances like fiber. The unmistakable scent is from a mixture of chemicals produced by bacteria, such as hydrogen sulfide. The shape and appearance of your stool is partially dependent on how long it remains in the body.

When freshly made by the body, stool is far less solid than the version we typically see. As stool is stored in the colon, water is drawn away until it becomes something more familiar to our eyes. After a bowel movement, any leftover stool is moved from the rectum back into the colon where water absorption resumes. Over time, this can cause the stool to dry out and become stiff and hard to pass. Conversely, if the stool spends too little time in the colon the result will be watery, flaky, or otherwise non-solid.

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How to Classify Your Stool

The Bristol Stool Chart is a handy medical reference that divides stool into seven types depending on its consistency. Knowing a bit about the chart can help inform you on the general condition of your own bowel movements. The chart comes up when determining if someone has constipation or diarrhea. Stool can be classified into the following:

  • Type 1: Separate, hard lumps or balls, usually harder to pass.
  • Type 2: A lumpy sausage that may resemble clumps stuck together.
  • Type 3: Stool that is similar to a sausage but with cracks or lines on the surface. It may also be plump.
  • Type 4: Stool that is snake-like, smooth and soft.
  • Type 5: Soft blobs with clear edges.
  • Type 6: “Fluffy” pieces of stool with ragged edges; mushy.
  • Type 7: Stool that is entirely liquid with no discernable solid pieces.

Generally speaking, types one and two are considered signs of constipation, types three and four are considered ideal and types five, six and seven are considered signs of diarrhea. Keep in mind that stool frequency also needs to be taken into account. Not everyone has a bowel movement every day, but you should have a bowel movement at least once every three days. Being “regular” means having a type three or a type four bowel movement at least three times per week with minimal straining.

The Toilet of Many Colors

Stool is normally brown due to the presence of bilirubin (bile), but it can come in a rainbow of different hues, shades and colors. These colors can be the result of something you ate, like a dye-rich food, or due to movement in the gastrointestinal tract:

  • Green: Bile is normally green and only turns brown after having time to break down. Green stool can mean that waste is being moved through the body too quickly. This could possibly be attributed to your diet. For example, green leafy vegetables, iron supplements, and food coloring can all result in greenish stool.
  • White: Whitish or clay-colored stool happens when there is minimal or no bile present at all. This means that there is a bile duct obstruction in the liver and you should see a doctor if it happens more than once. Some medications used to treat diarrhea can also result in white stool, which is a less problematic cause.
  • Yellow: Yellow stool is often greasy and exceptionally foul-smelling. This is due to excess fat or gluten being present. Although fat does get passed in stool, it is not normal to lose such a large amount and there’s a chance you may have a malabsorption disorder. Conditions like celiac disease will impact your body’s ability to process nutrients; as a result they may be expelled through stool. If you have yellow stool, talk to your doctor about getting evaluated.
  • Bright red: Blood in the bowl can be alarming, especially in large amounts, but when it comes to stool it may not be a large concern. Bright red blood means that there is bleeding somewhere along the lower GI tract and the biggest culprit is often a hemorrhoid. Beets, cranberries, tomato juice, and fruit punch mixes are also some of the substances capable of creating bright red stool.
  • Black: Black or maroon stool also indicates blood, but unlike bright red it can be a larger cause for concern. Black indicates that the blood came from higher up in the GI tract—likely the stomach or throat. Although iron supplements and black licorice can sometimes create black stool, you should definitely talk to your doctor if it happens more than once.

The Myth of the Perfect Stool

It is worth noting that there is no such thing as a “perfect” or “ideal” stool. While some types are obviously more problematic than others, it all ultimately comes down to what works for you. Someone who has a type 4 stool every day is not automatically better off than someone who experiences type 3 stool every two days. The important thing is that you are able to pass your stool without strain or pain.

Having said that, there are two traits of your stool that should be watched out for. The first is when your stool is narrow and pencil-thin. Speak to your doctor if you have more than one pencil-thin stool, since this can mean that there is an obstruction somewhere in the lower GI tract. The second is that your stool should not float. Stool is normally denser than water and sinks, so floaters can mean you are not absorbing fat and oil properly. They can also come from excess gas, so floaters aren’t an automatic concern unless you have them frequently.

We all cast a curious glance down at the bowl every now and then and wonder about what we see. Hopefully this little analysis clears up some questions.

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Sources for Today’s Article:
“Bristol Stool Chart,” Continence Foundation of Australia web site, http://www.continence.org.au/pages/bristol-stool-chart.html, last accessed November 25, 2015.
“Bristol stool scale,” Wikipedia web site, https://en.wikipedia.org/wiki/Bristol_stool_scale, last accessed November 25, 2015.
“Feces,” Encyclopedia Britannica Online web site, http://www.britannica.com/science/feces, last accessed November 25, 2015.
Hatfield, H., “The Truth About Poop: Understanding Stool Color, Shape, and Frequency,” WebMD web site, http://www.webmd.com/women/features/digestive-problems, last accessed November 25, 2015.
Picco, M. F., “Stool Color: When to Worry,” Mayo Clinic web site, October 12, 2012; http://www.mayoclinic.org/stool-color/expert-answers/faq-20058080.


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Dr. Victor Marchione, MD

About the Author, Browse Victor's Articles

Victor Marchione, MD received his Bachelor of Science Degree in 1973 and his Medical Degree from the University of Messina in 1981. He has been licensed and practicing medicine in New York and New Jersey for over 20 years. Dr. Marchione is a respected leader in the field of smoking cessation and pulmonary medicine. He has been featured on ABC News and World Report, CBS Evening News and the NBC Today Show and is the editor of the popular The... Read Full Bio »