Analysis/Stools

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Contents

Introduction

A lot of information can be gathered from just observing stools. Color, texture, consistency, and other properties can give clues to what is happening in digestion. This article is intended to help with stool detective work by parents and is only given as a guide. You will see there is some overlap and what comes out one day may be due to someone that happened on previous days due to transit time in the gut.[1]

Visually inspecting stools alone are not diagnostic of anything. Other symptoms and signs are generally present.

Disclaimer

The information provided in this article should not be used for diagnosing or treating a health problem or disease. It is not a substitute for professional care. Please consult a health care professional with further concerns.

Coloration Process

It is the addition of bile into the intestinal tract as part of the digestive process that actually turns the stool brown.

  1. Stool starts out green
  2. then turns bright yellow as it goes through the digestive tract.
  3. It is bile and bacteria that finally turn it brown.

Color Indications

Yellow or Green

Yellow or green stools can indicate stool is passing through the digestive tract too rapidly not giving it a chance to change colour. Bright yellow stools can also indicate not enough bile / bilary obstruction.

Dark-Colored

Dark-colored stools may be seen in platelet function disorders, iron deficiency anemia, cirrhosis, colorectal cancer, disseminated intravascular coagulation, peptic ulcer, or stomach cancer. Liver disease may include a yellow tone to the skin and whites of eyes (jaundice) and brownish urine.

Black or Tarray

Black or tarry stools (Melena) - the passage of black, tarry and foul-smelling stools; can be an indication of digested blood in the stool. Other causes are, iron deficiency anemia, cirrhosis, colorectal cancer, disseminated intravascular coagulation, peptic ulcer, or stomach cancer.

In advanced cirrhosis (liver disease), the abdomen becomes distended with fluid and ruptured blood vessels in the stomach and esophagus cause bleeding. The person may vomit blood or pass black stools. Very dark stools, for example, may indicate an ulcerative lesion in the higher digestive tract.

Image:Notepad.gif NOTE: The ingestion of black licorice, lead, iron pills, Pepto-Bismol, or blueberries can all cause black stools or false melena. Stools should be tested for the presence of hidden blood.

Blood in the Stool (Hematochezia)

The passage of red, or maroon - colored stools. Red or "frank" blood in the stool could be caused by hemorrhoids. Bloody stools can also be seen in amebiasis, anal fissures, or colorectal cancer.

Bright red bleeding with bowel movements may be due to hemorrhoids; however, other conditions such as colonic polyps or tumors, diverticulosis, and abnormal small vessels called AVMs also may cause bleeding.

Unusually, the bleeding is coming from the upper intestine or stomach. Bleeding such as you describe usually is evaluated by colonoscopy. Blood, as seen in the stool, can originate anywhere along the intestinal tract. A black stool usually means that the blood is coming from the upper part of the GI tract. At least 6 Tablespoons (or 200 milliliters) of blood must have been lost in order to cause passage of melena. Maroon-colored stools or bright red blood usually suggest that the blood is coming from large bowel or rectum. However, sometimes can be caused by massive upper GI tract bleeding. Some upper GI causes of bloody stools can also cause vomiting blood such as in peptic ulcer disease. The color of the stool can suggest the location of the bleeding however this is not reliable.

A definitive diagnosis will require radiographic and/or endoscopic investigation.

Black color -

  • bleeding ulcer
  • gastritis
  • esophageal varices
  • a tear in the esophagus from violent vomiting

Maroon color -

  • all the causes of black color stool
  • diverticular bleeding
  • vascular malformation
  • intestinal infection (such as bacterial enterocolitis)
  • inflammatory bowel disease
  • tumor
  • colon polyps or colon cancer

Bright red color -

  • all the causes of black or maroon color stool
  • hemorrhoids
  • anal fissures ("cracks" in the anal area)

Gray, Pale, Putty or Clay Colored

Gray stools, pale stools, putty or clay colored stools may be seen in hepatitis, gallbladder disorders, or malabsorption conditions. Bile salts in the stool excreted by the liver give it a normal brown color.

Obstruction to bile flow out of the liver (you may see the word "cholestasis"), or liver infections like viral hepatitis (A, B, C, etc.), may produce clay colored stools. Possible causes for clay colored stool result from problems in the biliary system (the drainage system of the gallbladder, liver, and pancreas): Malabsorption problems can cause undigested fat in the stool (steatorrhea) which is characterized by foul smelling, light yellow to gray, greasy or frothy stools. This may also be caused by low bile output.

Orange Stools

Orange stools may be due to certain medications. Beta-carotene (a form of vitamin A) may cause orange stools as a side effect so check any sources of vitamins or supplements, as well as intake of foods high in beta-carotene (carrots, sweet potatoes, etc.).

Another possibility is if the stool is more pale-orange, it might indicate lack of bile salt (which gives stool a brownish color). Other sources are antacids containing aluminum hydroxide, barium from recent barium enema test, and hepatitis. Consider checking some baseline liver tests to evaluate proper liver function.

Artificial orange or yellow colorings, or other artificial colorings can product orange stools.

Texture

Sand or Sandy appearance

When there is a lack of taurine, a sand-like substance can develop in the digestive system and show up in the stool.[2]

Sandy stools are commonly associated with a bile acid imbalance caused by a taurine deficiency.

  • Taurine is an amino acid in our body that is involved in the production of taurcholic acid.
    • Taurcholic acid helps produce bile in the liver.
      • Bile acids are involved in fat absorption.[2]

Long-standing intestinal inflammation, and sulfur depletion can contribute to this problem. [2]

Treatment: - Taurine, as a supplement of 100 to 500mg per day, can be helpful for some children.[2]

Image:Notepad.gif NOTE: Taurine helps to produce bile acids in the liver.

Heavy, fat-rich stools

Can indicate various intestinal and pancreatic disorders, and so forth. Can also be due to malabsorption or insufficient fat breakdown.

Diarrhea

The passage of an increased amount of stool. This is frequently considered to be 3 or more stools per day, or excessively watery and unformed stool.

Chronic diarrhea occurs when loose or more frequent stools persist for longer than two weeks.

Diarrhea causes can be grouped into several general categories.

  1. Infections
    • viruses
    • bacteria
    • parasites
  2. Toxins
    • Often referred to as 'food poisoning.' Toxins may be produced in foods as bacteria grow. These toxins are responsible for the associated vomiting and diarrhea.
  3. Malabsorption
    • lactose intolerance
    • celiac disease (sprue)
    • gluten malabsorption,
    • cystic fibrosis
    • cows milk protein intolerance
    • intolerance to specific foods (beans, fruit, etc.)
    • There are other less frequently encountered causes of malabsorption.
  4. Inflammatory Diseases of the Bowel
    • Crohn's disease
    • ulcerative colitis
  5. Immune deficiency
    • Medications
    • antibiotics
    • laxatives (especially those containing Magnesium)
    • chemotherapy
  6. Other

Floating

Stools that float are generally associated with some degree of malabsorption of foods or excessive flatus/gas. Floating stool is seen is a variety of different situations, the majority being diet-related or in association with episodes of diarrhea caused by an acute gastrointestinal infection.

A change in dietary habits can lead to an increase in the amount of gas produced by bacteria in the gastrointestinal tract. Similarly, acute gastrointestinal infections can result in increased air/gas content from rapid movement of food through the GI tract.

One misconception is that floating stools are caused by an increase in the fat content of the stool. In fact, increased air/gas levels in the stool make it less dense and allow it to float.

Another cause of floating stools is malabsorption. More than two weeks of diarrhea with floating stools is often seen in people suffering from malabsorption, a dysfunction in the GI tract that affects the body's ability to digest and absorb fat and other food. Increased levels of nutrients in the stool (those not absorbed by the GI tract) are supplied to the normal bacteria that live in the gut, which in turn produce more gas. This results in more air/gas- rich stool that floats.

Dietary changes, diarrhea, and malabsorption can cause floating stools. Most causes are benign and will resolve when the infection ends or the bacteria in the GI tract become accustomed to the changes in your diet.

Constipation

Severe constipation, or alternative constipation and 'diarrhea' (or loose stools) could be encopresis.

Image:Notepad.gif NOTE: Remember the Water!

Fiber is often recommended to help with constipation. The idea is to add fiber which will absorb more water into the colon and help make stools softer and easier to pass. This applies to over-the-counter sources as well as whole food sources.

But you need to remember to drink sufficient or even extra water too in order for this to work. If you are having problems with constipation, consider upping the water intake along with the fiber.

Odor

Extremely Foul

Stools normally have an unpleasant odor, but one that is recognized as fairly common or 'typical'. Stools that have an extremely bad, out- of-the-ordinary odor may be associated with certain medical conditions.

Foul-smelling stools also have normal causes, most notably diet. Foul smelling stools may occur in conjunction with floating stools.

Extremely foul smelling stools can be due to bacteria overgrowth. Some bacteria produce hydrogen sulfide which has a characteristic rotten egg smell (horrible stench). It can also be the putrifying debris in the gut.

Ammonia

Ammonia smelling stools can be attributed to bacteria overgrowth or nitrogen being insufficiently digested or improperly metabolized. When food is insufficiently digested, the non-absorbed food can then become food for harmful bacteria, or just putrefy, in the gut. Either of these leads to toxins being released in the body.

Sulfur

A few people noted that if they eat more sulfur containing foods and have a yeast problem, the yeast may feed on the sulfur foods and get worse. These cases also say an increase in yeast with sulfur supplements. Other supplements reported to produce a smell when not absorbed and metabolized well are selenium, glutathione, and SAMe.


Image:Notepad.gif NOTE: Besides smelly stools, a person many have bad body odor and bad breathe even shortly after taking a shower or brushing teeth.

Content

Yeast

Yeasty stools - "yeasty" stools indicate the presence of yeast, but are not the only indication of yeast. These may appear during either yeast growth or die-off. Possible yeast-looking stools include:

  • cottage-cheese looking stools
  • frothy stools…like yeast bread rising
  • yeasty smell to stools
  • stringy-ness to stools…like cheese strings

White Specs

White specs in stools:

  • Rice (undigested)
  • They've been eating paper or, something else they can't break down.

Image:Notepad.gif NOTE: For my daughter this would include any kind of bean, nut, seed, grain, vegetable, popcorn, etc. She initially was ok with rice but later on (about 10 mos.) stopped being able to digest pretty much anything. Eventually found white little seeds from the Mesa Sunrise Waffles.

Black Flecks

Black specks may be seeds, foods, or from die off of yeast or bacteria.

If you start any supplement that might create looser stools, temporary diarrhea, or die-off of yeast or bacteria (like an antibiotic, probiotic, digestive enzymes, antifungal, laxative, etc), you might see dark or black flecks in stool during this cleaning out period. Certain types of adverse bacteria in the colon can produce dark residues and this is getting cleaned out.


Mucous

Mucous is produced in the intestinal tract as way to coat and protect the gut lining. Having too much or too little mucous can cause problems.

Proteins are digested in the stomach, but carbs need to be digested in the intestines. If your child has leaky gut, the intestines will form a layer of mucous in the lining to protect itself from the irritating di and polysaccharides. But it also means that the natural enzymes in the intestines cannot get to the food b/c of the layer of mucous, so it becomes food for the yeast, microbes and bad bacteria living there.

Because the supplemental enzymes are digesting the food in the stomach, the food is not causing any more problems in the intestines and the need for protective mucous is decreasing.

Image:Notepad.gif NOTE: My son had mucous in his stools for about 3 weeks. It is the body clearing itself out and detoxing. The next thing I noticed after the mucous went away was a much more healthy skin tone which I think meant he was finally absorbing the nutrients from his food.

You can have mucous for a variety of reasons. However, since you know there was lots of gunk in there, and just started an enzymes/probiotic program with help cleaning out the gunk, the mucous can be sloughing off in this process.

The alternating stool consistency can also be part of this process. Allow a couple weeks for the bulk of the cleaning out to happen. I know there is the tendency to analyze things on a minute by minute or hour by hour basis, but the transit through the gut can be a matter of hours, days, or weeks. Allow about a week to evaluate changes in diet, supplements, or meds to see the net results (unless there are drastic healthy problems happening, of course)./

Autism-Mercury Poo Messages

Observation Subject/Link
Pale Re: Andy, Dana & others: dermatitis on GFCF, poop / liver problems
Green Re: Green poop detectives...
Green Re: Cause of green Poop?
Green Re: Green diarrhea
emerald green, puking Re: older chelation subjects
green, black, constipated Re: Possible Failure to Thrive?
Green, biotin Re: Apples--biotin
(Green), floating, fatty Re: Green Poop Revisited
Braided yellow, brown/green, prev. consti. Re: Andy: DMSA dosing schedule
Yellow poops during/after rounds and possible liver/blood issues
floating, mushy, distended belly Re: Andy- question regarding yeast and chelating agents
White Re: White stools
Re: liver help
well formed, darker Re: Dana: Taurine or ACE which to add first?
huge, formed Re: ALA
sandy, red ring Re: Questions about poop problem and gut health (long thread, many ideas
Loose Re: Loose bowels - will it ever end
Loose Re: poop question
Loose Re: ALA
rank smelling, liquid, bacteria Re: Anyone/Bacteria
yeast (constipation) vs bacteria (loose) symptoms Re: Caprylic acid vs Organic coconut oil
accidents, loose Re: what's going on with this kid?
bloated belly, smelly Re: Bacteria or Yeast?
less gas - pancreatic enzyme Re: Tackling yeast: what are the most important points?
itching, parasites Re: Parasites Keep Coming Back!
Yeast Re: Yeast?

Bibliography

  1. http://www.clevelandclinic.org/quality/08-20/08-20b.htm
  2. http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm

Links

References

  1. Message 31831
  2. 2.0 2.1 2.2 2.3 Kurt N. Woeller, D.O., From the Desk of Dr. Woeller, 16 Dec 2008
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