Tuesday April 11th, 2007
Hi,
My interest in having my patients check for changes in their
stool is quite personal. My brother-in-law Giles died of
colon cancer in August last year. He was only 43. He left behind
my sister and their 2 young children. He had been having blood in
his stool for a few months but didn't think that it was
important enough to report to his physician. He thought it was
just a bleeding hemorrhoid and "would go away". It was only when
the water in the toilet bowl was bright red after a bowel
movement that he realized something was not right and took it
seriously enough to go to the doctor. In a matter of days
he was diagnosed with stage IV colon cancer that eventually took
his life.
If you are not educating your patients to look at their stools I
urge you to begin. I believe that Giles would still be with us if
he had been educated by his physician to watch for changes in
stool color. Here are some of the important things that I think
you and your patients should pay attention to:
*** Blood on/in stool ***
This is always an abnormal state. Blood streaked on outer surface
usually indicates hemorrhoids or anal abnormalities; blood
present in the stool usually comes from higher in the colon and
may be the first sign of bowel cancer; if the bowel transit time
is rapid, the blood can be from stomach or duodenum and will
appear as bright or dark red. I urge you to take this sign
seriously and evaluate for the cause of the bleed.
*** Undigested food ***
This may indicate insufficient HCL and/or pepsin production. An
insufficiently acidic bolus of chyme moving into the intestines
from the stomach may not trigger sufficient cholecystokinin
release and a decrease in pancreatic enzyme production causing
pancreatic insufficiency. Also consider that your patient is not
chewing their food appropriately.
*** Mucous on stool ***
Mucous on the stool is usually due to gastrointestinal irritation
(colitis, food sensitivity, pancreatitis). Translucent gelatinous
mucus clinging to the surface of formed stool occurs in: spastic
constipation; mucous colitis; emotionally disturbed patients;
excessive straining at stool.
*** Loose stool
Loose but not watery stool is associated with mild intestinal
irritation and malabsorption.
*** Hard stool ***
This is usually due to increased absorption of fluid as a result
of prolonged contact of luminal contents with the mucosa of the
colon because of delayed transit time (lack of fiber,
dehydration, hypochlorhydria).
*** Floating stool ***
Consider malabsorption (esp. fats), reduced tract time due to
anxiety or irritation, and a high fiber diet. The stool may also
be described as slippery or greasy looking.
*** Ribbon-like shape ***
A ribbon-like stool suggests a possibility of spastic bowel,
rectal narrowing or stricture (pencil shaped), decreased
elasticity, or partial obstruction (uterus malposition,
prostatitis, polyp, tumor).
*** Small, round and hard ***
A condition called scybala this is found with habitual or
moderate constipation. Severe fecal retention can produce a large
amount of impacted masses in the colon with a small, round and
hard stool as overflow.
*** Brown ***
A brown colored stool is probably due to Sterobilin (urobilin), a
bile pigment derivative resulting from the action of reducing
bacteria in bilirubin. It is a normal finding.
*** Dark brown ***
A consistently dark brown stool is associated with an excessively
alkaline colon that may indicate dysbiosis. A dark brown stool
can be a normal finding indicating good bile flow and elimination
of fat-soluble toxins.
*** Yellow ***
Usually seen with severe diarrhea, may be due to lack of
intestinal flora and will also occur from antibiotic use.
Consider excessive bile secretions due to over stimulation or
irritation to the small intestine.
*** Black ***
This is usually a result of bleeding into upper GI tract (ulcer,
Crohn's, Colitis, cancer); also the use of drugs, iron, bismuth,
charcoal or a heavy meat diet.
*** Tan or clay colored ***
This is associated with a blockage of the common bile duct (lack
of bile pigments) as well as pancreatic insufficiency, which
produces a pale, greasy acholic stool. Consider gall bladder
insufficiency or hepatobiliary obstruction.
*** Offensive odor ***
Indole and Skatole, intestinal toxins formed from intestinal
putrefaction and fermentation by bacteria, are primarily
responsible for odor.
If the stool usually has an offensive odor then consider that it
may be due to malabsorption, food decay, or dysbiosis
If the stool is occasionally offensive then consider intermittent
malabsorption with food decay and dysbiosis.
I hope you have found this useful and can begin to educate your
patients on this sometimes embarrassing but I think essential
topic!
All the best
Dicken
Weatherby & Associates, LLC
7000 Little Applegate Road
Jacksonville
, OR
97530
http://www.BloodChemistryAnalysis.com
