Signs of Poor Digestion-Bowel Problems

Signs of Poor Digestion-Bowel Problems
This section of the blog offers a quick glance at a somewhat familiar disorder called Functional Dyspepsia (FD).  The medical term simply means - bad digestion, the symptoms vary but are frequently described as a full or bloated feeling after eating.

Healthy Liver - Healthy Digestion

The Liver And Digestion
The liver performs many essential functions related to digestion, metabolism, immunity, and the storage of nutrients within the body.  In digestion the liver produces bile, which is responsible for digesting fats for easier absorption, bile, is a fluid that contains among other substances, water, chemicals, and bile acids (made from stored cholesterol in the liver). Bile is stored in the gallbladder and when food enters the duodenum (the first part of the small intestine), bile is secreted into the duodenum, to aid in the digestion of food. 

Functional Dyspepsia
You're having trouble with your stomach. You feel uncomfortable. It's not heartburn, but it may be related to eating. You feel bloated and full. You complain of nausea or sometimes you even vomit. You think you might be having “indigestion.”

It's called dyspepsia — literally, “bad digestion.” It is derived from the Greek dys, which means bad, and peptein, which means “to cook” or “to digest.”

The term functional dyspepsia (FD) is used to describe chronic and persistent upper abdominal pain that's often related to eating, and for which there is no clearly identifiable cause such as peptic ulcer disease. Because peptic ulcer disease produces similar symptoms, functional dyspepsia is sometimes called non-ulcer dyspepsia.

In most cases, the uncomfortable upper abdominal symptoms appear after eating, but there's no difficulty in swallowing. Sometimes the discomfort begins during the meal, sometimes about half an hour later. It tends to come and go in spurts over a period of about three months.

This condition affects about a quarter of the population — twice as many as have peptic ulcer disease — and it hits men and women equally. It's responsible for a significant percentage of visits to primary care doctors. Many people suspect they're suffering from ulcers, but are found not to be. The cause of FD is unknown. Even more frustrating, there's no sure-fire cure.

Is it an ulcer?
The first question on most people's minds is, “Do I have an ulcer?” It's a reasonable question, considering that 10% of Americans develop a peptic ulcer at some time in their lives.
Peptic ulcers are raw, crater-like breaks in the mucosal lining of the digestive tract. They occur in the stomach and duodenum and are linked to the erosive action of gastric acid and sometimes to a reduction in protective mucus (see Figure 5). In essence, the stomach, which is designed to digest foods, is digesting a part of its own lining. These localized, generally circular craters are rarely more than an inch in diameter.

Diagnosing peptic ulcers
A peptic ulcer is a raw, crater-like break in the lining of the stomach or duodenum. To diagnose this condition, physicians often first prescribe medication. If the pain persists, a physician can use a tube with a lighted scope at the end known as an endoscope to view the lining of the stomach and confirm the presence of an ulcer.
In the early 1980s, researchers made a major discovery. They identified Helicobacter pylori, a spiral bacterium with an affinity for the stomach, as a major culprit in ulcer disease. H. pylori is the cause of many peptic ulcers. At least 90% of people with duodenal ulcers and 75%–85% of those with gastric ulcers are infected with this organism.

Bacteria in the gut Helicobacter pylori is a bacteria that thrives in the stomach because it can produce large quantities of urease, an enzyme that generates ammonia which neutralizes the acid and quickly kills other bacteria. The corkscrew-shaped H. pylori attaches to the surface of stomach cells, after twisting through the mucus that protects the lining from corrosive gastric juices. Scientists believe that H. pylori contributes to ulcers in several ways including thinning the protective mucous layer, poisoning nearby cells with ammonia or other toxins, or even increasing acid production.
Certain medications can add to the irritation. Talk to your doctor to see if any of the medications you are taking may be causing your symptoms. Cigarette smoking impairs the healing of ulcers, and stress appears to aggravate ulcer symptoms. Studies show there's also a genetic component, as peptic ulcers sometimes run in families. They occur more often in people with type O blood than in those with other blood types.

Symptoms of functional dyspepsia

• Persistent upper abdominal pain that occurs during or after eating
• Bloated, full feeling
• Symptoms come and go over days or months

Diagnosing FD
People with functional dyspepsia have the symptoms of an ulcer without the ulcer itself. Both conditions seem to be stress-related and affect people of all ages. In many cases, the symptoms of both may respond to treatment with a placebo pill (one that contains no active ingredient). In both conditions, pressing on the patient’s abdomen may produce tenderness.
Typically, the first step is to confirm or exclude the possibility of a peptic ulcer. Pain is the most common symptom of an ulcer. Usually, it is a dull, gnawing ache that comes and goes. It occurs two to three hours after a meal, or in the middle of the night, and is relieved by food.

Your medical history and details about the frequency of the pain (how long it's persisted, and when it's most severe) are important in making this diagnosis. Discomfort that feels worse on an empty stomach and is relieved by eating suggests a duodenal ulcer, although it isn't definitive. Ulcer pain often awakens a person during the night. If this pain is relieved by medications that typically help GERD symptoms, it may indicate an ulcer. Other health habits are also relevant, such as whether you smoke or drink alcoholic beverages, and whether other family members have ever been diagnosed with a peptic ulcer.

Symptoms of an ulcer
Aside from dyspepsia, other symptoms that may point to an ulcer, rather than to FD, include:

• Evidence of bleeding, such as vomiting blood or material that resembles coffee grounds, or passing black stools.
• Repeatedly vomiting large amounts of sour juice and food, which can signal an obstructing ulcer.
• Sudden, overwhelming pain — a rare but frightening signal that the ulcer has perforated the stomach or duodenal wall.

To confirm the presence of an ulcer, the doctor may order an endoscopy or upper GI series. At the same time, some physicians may be hesitant to order these tests because in most instances of dyspepsia, results are negative and are unlikely to influence initial treatment strategies. Still, most patients take comfort in learning that he or she doesn't have an ulcer.
Diagnosing FD is further complicated by the disorder's resemblance to other illnesses. Gastritis, gastroesophageal reflux, irritable bowel syndrome, chronic pancreatitis (inflammation of the pancreas), stomach cancer, and hepatobiliary pain (pain originating from the liver or gallbladder) all can cause symptoms much like those of FD (see “Functional dyspepsia: What else could it be?”).

Functional dyspepsia: What else could it be?
At least some of the distress associated with FD is due to the nagging fear that a more serious condition may be going undetected. This is hardly ever the case, especially when symptoms persist for months or years without worsening. Fortunately, more serious ailments have characteristics that set them apart from FD.

Gallstones.
Stones can dwell silently in the gallbladder or can produce painful attacks, typically after a large, high-fat meal, if the gallbladder contracts and a stone lodges in its neck. The pain is usually located just under the right rib cage and may radiate to the right shoulder or back. If a stone is stuck for several hours, inflammation can result, and the patient may experience extreme tenderness if a hand is pressed below the ribs on the right side. He or she may develop fever and an elevated white blood cell count. Jaundice (a yellowing of the skin and the whites of the eyes), dark urine, and pale stools occur when a gallstone slips out of the gallbladder and obstructs the duct that drains bile from the liver into the duodenum.

Stomach cancer.
Malignancies of the stomach generally occur later in life, after age 50. Tumors that burrow into the stomach wall often produce symptoms that resemble those associated with ulcers. Eating a full meal can become impossible if growths extrude into the hollow of the organ or spread through the stomach wall, making it too stiff to expand. Warning signs include bleeding, persistent vomiting, a constant sense of nausea or fullness that interferes with normal eating, and weight loss.

Tests
As a first step toward both diagnosis and treatment, your doctor may try you on one or more drugs to see if the dyspepsia clears. He or she may also order a blood test to detect the presence of H. pylori bacteria. If the blood test is positive, treatment can eradicate the bacteria. If symptoms have not improved after a few weeks, the next step will probably be endoscopy to check for ulcers.

People over age 45 with a new onset of dyspepsia, and those with a family history of gastrointestinal cancers, should see their doctors promptly — as should patients whose dyspepsia is associated with additional worrisome symptoms, such as weight loss, dysphagia (difficulty swallowing), gastrointestinal bleeding, or anemia (low blood count).

Causes of FD
Although there are several theories, no one really knows what causes FD. Many experts don't think that excess gastric acid is to blame. Studies have found no irregularities in acid secretion of dyspeptic patients and no correlation between symptoms and increased acid production. But the theory remains under consideration, as does the possibility that the abdominal pain associated with FD results from acid leaking through the mucosa, which has been altered in some way.

Some other ideas:

Visceral hypersensitivity.
Many experts believe that patients with FD are more sensitive to gastrointestinal stimuli than people without FD, and that they may have a lower threshold for pain than their healthy counterparts.

Abnormal motility or sensation.
The symptoms of FD may reflect abnormal motility, that is, the spontaneous movement of the digestive tract. Some patients' stomachs empty more slowly than normal, so food is retained longer. The patient feels as though food is not leaving the stomach; he or she fills up quickly during a meal and may belch or burp. The problem may be a mechanical failure of gastric contractions to empty the stomach. In addition, some FD patients have relatively stiff stomach walls, so that little distention can occur after a meal.

H. pylori infection.
While the role of H. pylori infection as a cause of ulcers and gastritis is established, its involvement in FD is unclear. H. pylori infection is only slightly more common in people with FD than in the general population. Although the organism may contribute to FD symptoms in some cases, there's currently no way to distinguish these people from those in whom H. pylori does not cause FD. In most cases, eradicating H. pylori doesn't significantly improve FD symptoms.

Duodenitis.
Another condition that might produce symptoms of FD is duodenitis, a chronic inflammation of the lining of the duodenum. However, less than 20% of people with FD have this condition. Some physicians regard duodenitis as a precursor to peptic ulcer disease and may treat it as they would an ulcer.

Psychological factors.
Although scientific data are scarce, psychological stress may be important in the development of some cases of dyspepsia.

Diet.
Certain fatty foods and fatty acids are often blamed for dyspepsia. This connection makes sense because fat ingestion not only delays gastric emptying but also increases distention of the stomach. However, in one study, when people with a professed sensitivity to fats ate high-fat foods that were disguised, they didn't experience dyspepsia. Substances like alcohol and coffee may also aggravate symptoms.

Drugs.
Certain medications can cause dyspepsia, ulcers, and gastritis. It's important to check with your doctor to see if anything you are taking could be contributing to functional dyspepsia.

Managing FD
No truly effective medication exists to treat FD. Still, for some, the knowledge that the condition isn't something more serious may cause the symptoms to disappear or at least become less troublesome. For others, however, the symptoms continue. There's no scientific basis for choosing a specific medication in a person with FD because the stomach and duodenal lining are intact and no pathological problem has been identified. Normally, there's no excess gastric acid production, or demonstrated motility problem, so medications to correct those conditions make no sense.

Lifestyle modifications for FD
The following lifestyle modifications may prove helpful.

Eating strategies

• Avoid foods that trigger symptoms (see “Foods that may aggravate functional dyspepsia”).
• Eat small portions, and avoid overeating.
• Eat smaller, more frequent meals.
• Chew your food slowly and completely.
• Don't drink during meals.
• Avoid activities that result in swallowing excess air, such as smoking, eating quickly, chewing gum, sipping through straws, and drinking carbonated beverages.
• Don't lie down within two hours of eating.
• Keep your weight under control. 

Foods that may aggravate functional dyspepsia

• Alcohol
• Beans
• Caffeinated tea
• Coffee
• Colas
• Dairy products
• Fried foods
• Orange juice
• Peanuts
• Peppers
• Radishes
• Spicy sauces
• Tobacco
• Tomato juice

Stress reduction
Use stress reduction techniques, including relaxation therapies, biofeedback, cognitive-behavioral therapy, exercise, or listening to soothing music.

Reduce fatigue

• Get enough rest.
• Adopt a bedtime routine. Go to bed, and get up at the same time each day.
• Avoid caffeine after noon.
• Don't get too much sleep.


• Exercise

• Perform aerobic exercise three to five times a week for 20–40 minutes per session. Seek your doctor's permission before starting any new workout routine.
• Don't exercise immediately after eating.

Signs of Poor Digestion

by Contributed - Story: 64755

Sep 20, 2011 / 5:00 am

The Obvious Signs

The most common and obvious signs of poor digestion and absorption include gas, bloating, heartburn, indigestion, cramping, constipation, diarrhea, and abdominal pain. While these signs and symptoms may be very obvious to many people they are often ignored for long periods of time until they become severe. If you experience any of the above symptoms it is important to pursue appropriate diagnosis and treatment because they are warning signs for further complications in the future.

Abdominal Pain

The location and nature of abdominal pain can be helpful in diagnosing the problem in the digestive tract. Pain in the lower right abdominal quadrant associated with fever is likely an appendicitis. Severe flank pain that radiates to the back often involves the gall bladder. Pain and burning feeling radiating to the chest often involves the stomach and esophageal sphincter.

Unfortunately, diagnosing solely based on the location and nature of abdominal pain is not accurate enough to rely on in many cases the pain receptors and nerves in the digestive tract are not very geographically accurate. There are over a dozen legitimate causes of abdominal pain in the lower left quadrant. The most likely culprit is diverticulosis but it is important to do a full investigation and not just rely on the most likely cause.

Upper Digestive Tract

The upper digestive tract includes the oral cavity, esophagus, and stomach. Problems in the upper digestive tract usually manifest immediately upon consumption of food in the oral cavity and upper esophagus to within 60 minutes in the lower esophagus and stomach. Severe problems in this area can cause black coffee ground-like components to the stool.

Mid Digestive Tract

The mid digestive tract includes the pyloric sphincter, the upper portion of the small intestine (duodenum), the middle portion of the small intestine (jejunum), the pancreas, gall bladder, liver, and ducts that connect to the duodenum. This is the part of the digestive system most associated with absorption. Problems in the mid digestive tract usually manifest between one and two hours after food consumption. They tend to produce digestive symptoms that get better more than two hours after eating. Severe problems in the mid digestive tract can cause deep and dark red blood in the stool.

Lower Digestive Tract

The lower digestive tract includes the lower portion of the small intestine (ileum), the appendix, the ascending colon, transverse colon, descending colon, sigmoid colon, and anus. Severe problems in the lower digestive tract can cause bright red blood in the digestive tract.

Bowel Movements

The characteristics and qualities of your bowel movements are one of the most important indicators for the health of the digestive system. Constipation, diarrhea, pain, straining, urgency, and leakage are all signs of digestive system dysfunction. Blood, undigested food, mucus, and fat in the stool also indicate problems with digestion and absorption.

The Perfect Poo

The perfect poo (bowel movement) should look like a brown banana. It should be cylindrical, light brown in colour, solid, and have mild odour. One to three satisfying bowel movements per day is normal and healthy. A satisfying bowel movement should feel like a full evacuation that didn’t require strain or stress to complete. If your poo does not fit the description of the perfect bowel movement your body is telling you something is wrong.

In next week’s column we will investigate 3 more signs of poor digestion.

Stool Color Overview

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

The color of stool normally is brown. The reason for the brown color is the presence of bile in the stool. Bile is made by the liver, concentrated and stored in the gallbladder, and secreted into the intestine to aid in the digestion of food. Depending on the amount of bile it contains, the normal stool color can range in color from light yellow to almost black.

Bile secreted from the gallbladder into the intestine is a very dark green liquid made up of many chemicals, one of which is bilirubin. When red blood cells are destroyed naturally in the body, the hemoglobin, a protein inside the red blood cells that carries oxygen, is modified in the liver. The by-product of this process is bilirubin, and the liver secretes the bilirubin into bile.

As the bile travels through the intestines, it can undergo further chemical changes, and its color can also change. For example, if the traveling time through the intestine is too rapid, then bile won’t have the time to go through additional color changes and the stool color may be close to green.

The color of stool can change for other reasons as well. Many changes in stool color may not be of much importance, especially if the change happens once and is not consistent from one stool to the next. Sudden major changes in stool color that persist may suggest an underlying medical problem.

Furthermore, gradual but persistent changes in stool color also can signify medical problems.

Some of the important colors of stool that can signify problems include:

red,

maroon,

black,

clay-colored,

pale, orange, and

yellow.

Stool Color Changes Causes

Stool color can change for a variety of reasons. Some stool color changes may signify an underlying medical condition, and others may be due to ingestion of food or medications.

Dark Colored Stools

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 Tarry, Sticky Stools

Bleeding in the stomach or the intestines can change the color of stool. If bleeding occurs in the stomach or the upper part of the small intestine, the stool may turn black and sticky, described medically as black, tarry stool. Generally, black, tarry stool also is foul-smelling. This change in color and consistency occurs because of chemical reactions to blood within the intestine that are caused by digestive enzymes within the intestines.

Maroon or Red Stools

Red or maroon colored stools can also mean the presence of blood in your stools; in the medical field this condition is called hematochezi.

The difference between this color and the black or tarry color is the location of the bleeding. A red or maroon colored stool usually indicates a fresher blood and therefore lower GI bleeding.

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)

Not all red colored stools are caused by bleeding, as some foods can have the same effect. If you’ve recently consumed red-colored gelatin, popsicles, Kool-Aid, tomato juice, soup and/or beets, you may experience reddish stools

Black Stools (Not Sticky, No Odor)

Other causes of black stool are iron pills or bismuth-containing medications (such as, bismuth subsalicylate or Pepto Bismol). If the stool color is dark because of any of these medications, it is typically not sticky in texture and is not foul-smelling .

Gray or Clay-Colored Stool

Stool can be gray or clay-colored if it contains little or no bile. The pale color may signify a condition (biliary obstruction) where the flow of bile to the intestine is obstructed, such as, obstruction of bile duct from a tumor or stone.

A stool that appears clay in color is often seen in cases of mal-absorption, hepatitis, or gallbladder disorders.

Hepatitis and gallbladder disorders often interrupt the flow of bile out of the liver. This disruption will cause the clay color of the stool. Mal-absorption also disrupts the output of bile by increasing the amount of undigested fat in the stool. Bile is responsible for breaking down stool and making it brown in color. When the production is lowered the stool can appear clay in color.

Yellow Stool

Stool that is yellow may suggest presence of undigested fat in the stool.

This can happen as a result of diseases of pancreas that reduce delivery of digestive enzymes to the intestines, such as chronic pancreatitis (long standing inflammation and destruction of the pancreas usually due to alcohol abuse) or obstruction of the pancreatic duct that carries the enzymes to the intestines (most commonly due to pancreatic cancer).

The digestive enzymes released from the pancreas and into the intestines are necessary to help digest fat and other components of food (proteins, carbohydrates) in the intestines so that they can be absorbed into the body.

If the pancreas is not delivering enzymes into the intestines, then components of food, especially the fat, can remain undigested and unabsorbed. The stool containing the undigested fat may appear yellowish in color, greasy, and also smell foul.

Stool Color Changes Symptoms

The symptoms associated with changes in the color of stool generally correspond to the underlying cause (although the presence of large amounts of blood alone may lead to diarrhea and possibly cramping). In many instances, there may not be any symptoms associated with changes in the color of stool.

Bleeding from the gastrointestinal tract (esophagus, stomach, small intestine, large intestine) leading to red, maroon, or black tarry stools may be without any symptoms at all or may have accompanying symptoms of abdominal pain due to the underlying cause of the bleeding, for example, an ulcer;

nausea, vomiting of blood, diarrhea, and cramping due to the presence of blood in the stomach and/or intestines; and weakness, lightheadedness, and dizziness, due to the loss of blood from the body.

Persistently gray or clay-colored stools suggest some type of obstruction to the flow of bile. Obstruction caused by gallstones usually is associated with pain on the right side of the abdomen. However, cancer of the bile duct or cancer of the head of pancreas, which also can cause obstruction to the flow of bile by pressing on the bile duct, may not be associated with abdominal pain unless the tumor is large. The obstruction to the flow of bile causes backup of bile into the blood resulting in yellowness of skin and eyes that is referred to as jaundice.

Yellow stool as a result of undigested fat also may occur with no symptoms. If present, the most common symptom associated with yellow stool will be abdominal pain as a result of chronic pancreatitis, tumor of the pancreas, or obstruction of the pancreatic duct.

Orange Stool

If your stool shows orange coloring, it can usually be attributed to foods or medications that you may be taking. Certain medications with beta-carotene (such as a form of vitamin A) can cause orange coloring of your stool. Antacids which contain aluminum hydroxide can also cause orange stool.

Foods that are high in beta-carotene can have the same orange effect on your stool. These include; carrots, sweet potatoes, kale, spinach, turnip greens, winter squash, collard greens, cilantro and fresh thyme. Lastly any foods that have yellow or orange artificial colorings can also cause orange colored stool.

If you can’t attribute your orange stool with anything you ingested, then it may be caused by a lack of exposure to bile salt. Stool starts out as green, and then turns to a yellow-orange in color before being exposed to bile and bacteria which turns the stool brown.

Low exposure to bile salt can be caused by a couple different factors. First, your transit time is so fast that your stool is being pushed through your digestive system too quickly. This quick movement of stool reduces the exposure to bile salt resulting in orange stool.

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.

Infections – viruses, bacteria, parasites

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.

Malabsorption – lactose intolerance, celiac disease (sprue) or gluten malabsorption, cystic fibrosis, cows milk protein intolerance, intolerance to specific foods (beans, fruit, etc.) There are other less frequently encountered causes of malabsorption.

Inflammatory Diseases of the Bowel – Crohn’s disease, ulcerative colitis

Immune deficiency

Medications – antibiotics, laxatives (especially those containing Magnesium), chemotherapy

Floating stools

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.

Stinky stools

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 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 smell – 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.

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

When to Seek Medical Care

Individuals should notify their physician when there is a persistent change in the color of their stool.

Persistent black, tarry stools or red, bloody stools signify intestinal bleeding and need to be evaluated by a physician promptly. Individuals should either notify their primary care doctor or visit an urgent care center or emergency room.

Gray or clay-colored stool and yellow stool also may signify diseases of the pancreas, gallbladder, or the liver. The evaluation of these conditions may warrant careful evaluation by an internist, primary care physician, or a gastroenterologist (a physician specialized in disease of the stomach and the intestines).

Exams and Tests

The evaluation of changes in stool color typically begins with a thorough physical examination and personal medical history. The doctor may ask about intake of alcohol, smoking, and other habits. Family history of any cancers, particularly of the liver or pancreas or bleeding problems may be helpful. A review of medications that may affect the color of stool, including over-the-counter (OTC) medications, also is important. Any changes in bowel habits (constipation, diarrhea, and change in frequency) or any pertinent symptoms (pain with or without eating, nausea, vomiting, weight loss, etc.) can provide valuable clues in evaluating the underlying causes of changes in stool color.

Diagnostic testing to find the cause of changes in stool color typically start with simple blood tests including complete blood count (CBC), chemistries, liver enzymes (comprehensive metabolic panel or CMP or SMA 19), and blood clotting (coagulation). These tests can demonstrate anemia, liver disease, gallbladder disease, or other underlying conditions that may be responsible for the changes in stool color. Pancreatic enzymes–amylase and lipase–also can be measured to determine if pancreatic disease is present.

If bleeding from the stomach or intestines is suspected but the stool is not visibly black, red or maroon, occult blood (a small amount of blood that does not cause the color of stool to change much) can be sought by testing the stool directly for blood with a dye (fecal occult blood test or FOBT). This test relies on a chemical reaction between a solution (called guaiac) and hemoglobin in a sample of stool. In the presence of hemoglobin, the drop of solution will turn the stool sample (smeared onto a special paper which reacts chemically with the solution) blue. This test is part of the recommendation for screening for colon cancer, although in clinical practice, it is often used to determine if any bleeding is occurring in the gastrointestinal system. In addition to the test using guaiac, there is an immunological test for blood in the stool that uses an antibody to hemoglobin to detect the blood.

Methods to evaluate a change in the color of stool are upper gastrointestinal endoscopy (esophago-gastro-duodenoscopy or EGD) and colonoscopy. These tests are done by gastroenterologists to look inside the esophagus and stomach (EGD) and the colon (colonoscopy) with a video camera to detect the source of the bleeding or other abnormality that may explain the change in stool color. If necessary, biopsies can be taken with these techniques.

More advanced endoscopic testing to look for obstruction of the biliary or pancreatic ducts is called an endoscopic retrograde cholangio-pancreatography or ERCP. This test is performed like an EGD except that during the test dye is injected into the bile and pancreatic ducts to look with X-rays for obstruction of the ducts.

Other imaging studies sometimes are necessary in order to find the cause of the change in stool color. Computerized tomography (CT scan) is ordered frequently by physicians if the change in stool color is believed to be related to underlying cancer, pancreatic disease, or obstructive conditions of the bile ducts and gallbladder. Ultrasound of the abdomen is a frequently used, relatively inexpensive and reliable test to evaluate for gallstones or blockage of the gallbladder. Magnetic resonance imaging (MRI) of the abdomen sometimes is done to look more closely at any obstructive disease of the biliary or pancreatic ducts.

Stool Color Changes Treatment

The treatment for changes in stool color depends on the cause. As described earlier, some changes in the color of stool can be due to the color of the ingested food. Other more important medical causes may require simple or extensive medical evaluation and treatment.

Self-Care at Home

As for self care, it is important to recognize whether the change in stool color is persistent, recurrent or transient. Generally, changes in stool color that are transient, for example, once or twice, and then return to normal are not as important as persistent or recurrent changes.

Some of the symptoms associated with changes of stool color also are important to recognize. For example, if the stool is red, maroon or black, signifying bleeding from the intestines, then symptoms of abdominal pain, lightheadedness, or dizziness (from losing too much blood) may prompt someone to seek medical care more urgently.

Medical Treatment

Medical treatment for change in stool color can vary widely depending on what the cause is.

Some common scenarios include gastrointestinal bleeding resulting in red, maroon, or black looking stool. In most cases, these are dealt with by gastroenterologists either in their office or in a hospital setting. Depending on the patient’s description, physical examination, medical history, and results of diagnostic testing, the doctor may decide to treat with medications for stomach ulcers or inflammation in the stomach or the intestines.

In some situations, a specific treatment may not be available for certain types of bleeding, and the patient may only be asked to stop taking medications that can promote further bleeding (aspirin or nonsteroidal antiinflammatory drugs [NSAIDS]).

Sometimes medications are injected into the sites of the bleeding during endoscopic evaluations to help stop the bleeding. In rare situations where bleeding continues despite aggressive medical care, radiologists may pass catheters through the arteries and inject the smaller arteries that are feeding the site of bleeding with chemicals or beads to reduce the bleeding. Surgery may be required to remove part of the intestine that is the site of bleeding.

Clay-colored or gray stools also are evaluated by gastroenterologists as well as surgeons. If the change in color is caused by a stone obstructing the bile or pancreatic duct, the gastroenterologist sometimes can remove the stone by performing an ERCP. In other cases, surgery may be necessary to remove a stone or a tumor.

Next Steps

Follow-up

Change in stool color can be followed based on the cause and based on recommendation of the treating doctor.

Prevention

Prevention of change in stool color may be meaningless without knowing the cause. Since stool color can change for a variety of reasons, any preventive measure for the cause may play a role in preventing further changes in stool color.

For example, if the stool is black and tarry because of a bleeding ulcer, then avoiding medications that can cause bleeding, such as aspirin, may be a reasonable preventive measure. Avoiding alcohol can be a preventive measure against yellow stools resulting from undigested fat in stool due to pancreatic disease.

On the other hand, some causes of changes in the color of stool, for instance, cancer of the pancreas, may not be preventable.

Outlook

The outlook for changes in stool color varies with the underlying cause. For example, many causes of bleeding from the stomach or the intestines are benign, such as ulcers, and generally carry good prognoses while bleeding due to a cancer carries a less favorable diagnosis.

Synonyms and Keywords

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Author and Editor

Author: Saimak T. Nabili, MD, MPH

Editor: Jay W. Marks, MD

REFERENCE: MedicineNet.com. 

“Stool Color Changes (Black, Red, Maroon, Green, Yellow, Gray, Tarry, Sticky).

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The Bristol Stool Scale 

The Bristol Stool Scale was developed in the United Kingdom by a small team of gastroenterologists at the University of Bristol. It is designed to be a representative explanation for stools commonly seen in toilet water. In the different categories, the chart explains the correlation between the stool's physical attributes and the length of time the stool remained in the colon.

This scale is useful to anyone who would like to determine the condition of their colon because it is a generic indicator; it is not an absolute diagnostic tool. It is, however, a good indicator of what action you may need to take. Below are the chart and the analysis for your use at home.

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» Type 1: Separate hard lumps, like nuts

Typical for acute disbacteriosis. These stools lack a normal amorphous quality, because bacteria are missing and there is nothing to retain water. The lumps are hard and abrasive, the typical diameter ranges from 1 to 2 cm (0.4–0.8”), and they’re painful to pass, because the lumps are hard and scratchy. There is a high likelihood of anorectal bleeding from mechanical laceration of the anal canal. Typical for post-antibiotic treatments and for people attempting fiber-free (low-carb) diets. Flatulence isn’t likely, because fermentation of fiber isn’t taking place

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» Type 2: Sausage-like but lumpy

Represents a combination of Type 1 stools impacted into a single mass and lumped together by fiber components and some bacteria. Typical for organic constipation. The diameter is 3 to 4 cm (1.2–1.6”). This type is the most destructive by far because its size is near or exceeds the maximum opening of the anal canal’s aperture (3.5 cm). It’s bound to cause extreme straining during elimination, and most likely to cause anal canal laceration, hemorrhoidal prolapse, or diverticulosis. To attain this form, the stools must be in the colon for at least several weeks instead of the normal 72 hours. Anorectal pain, hemorrhoidal disease, anal fissures, withholding or delaying of defecation, and a history of chronic constipation are the most likely causes. Minor flatulence is probable. A person experiencing these stools is most likely to suffer from irritable bowel syndrome because of continuous pressure of large stools on the intestinal walls. The possibility of obstruction of the small intestine is high, because the large intestine is filled to capacity with stools. Adding supplemental fiber to expel these stools is dangerous, because the expanded fiber has no place to go, and may cause hernia, obstruction, or perforation of the small and large intestine alike.

» Type 3: Like a sausage but with cracks in the surface

This form has all of the characteristics of Type 2 stools, but the transit time is faster, between one and two weeks. Typical for latent constipation. The diameter is 2 to 3.5 cm (0.8–1.4”). Irritable bowel syndrome is likely. Flatulence is minor, because of disbacteriosis. The fact that it hasn’t became as enlarged as Type 2 suggests that the defecations are regular. Straining is required. All of the adverse effects typical for Type 2 stools are likely for type 3, especially the rapid deterioration of hemorrhoidal disease.

» Type 4: Like a sausage or snake, smooth and soft

This form is normal for someone defecating once daily. The diameter is 1 to 2 cm (0.4–0.8”). The larger diameter suggests a longer transit time or a large amount of dietary fiber in the diet.

» Type 5: Soft blobs with clear-cut edges

I consider this form ideal. It is typical for a person who has stools twice or three times daily, after major meals. The diameter is 1 to 1.5 cm (0.4–0.6”).

» Type 6: Fluffy pieces with ragged edges, a mushy stool

This form is close to the margins of comfort in several respects. First, it may be difficult to control the urge, especially when you don’t have immediate access to a bathroom. Second, it is a rather messy affair to manage with toilet paper alone, unless you have access to a flexible shower or bidet. Otherwise, I consider it borderline normal. These kind of stools may suggest a slightly hyperactive colon (fast motility), excess dietary potassium, or sudden dehydration or spike in blood pressure related to stress (both cause the rapid release of water and potassium from blood plasma into the intestinal cavity). It can also indicate a hypersensitive personality prone to stress, too many spices, drinking water with a high mineral content, or the use of osmotic (mineral salts) laxatives.

» Type 7: Watery, no solid pieces

This, of course, is diarrhea, a subject outside the scope of this chapter with just one important and notable exception—so-called paradoxical diarrhea. It’s typical for people (especially young children and infirm or convalescing adults) affected by fecal impaction—a condition that follows or accompanies type 1 stools. During paradoxical diarrhea the liquid contents of the small intestine (up to 1.5–2 liters/quarts daily) have no place to go but down, because the large intestine is stuffed with impacted stools throughout its entire length. Some water gets absorbed, the rest accumulates in the rectum. The reason this type of diarrhea is called paradoxical is not because its nature isn’t known or understood, but because being severely constipated and experiencing diarrhea all at once, is, indeed, a paradoxical situation. Unfortunately, it’s all too common.