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Gastroenterology and Health

Bowel Health, The Bowel Book

There Are Stools And There Are Stools

By Dr. W. Gifford Jones

December 7, 2004

This column is written with tongue in cheek. But are you bored as I am, at holiday dinner parties listening to friends talk about their blood cholesterol level or the latest treatment for arthritis? If so, and you don't mind not being invited again, start discussing stools. The point is that not all stools are created equal and their composition often tells the difference between being healthy or ill.

So what constitutes a healthy stool? Dr. Michael Levitt, an Australian colonrectal surgeon, has written a witty book titled, The Bowel Book. He says that the human gastrointestinal tract (GIT) was designed to operate best when stools resemble the shape and consistency (although not the same colour) of an unripe banana.

There's no doubt your dinner companions can hardly wait to hear how this can be achieved. Dr. Levitt says that getting the right amount of fiber is the first step to a healthy stool. Normal stools are about 75 percent water. And that dietary fiber, by holding onto water, makes stools soft as toothpaste.

Several years ago while writing about the value of fiber, I suggested that if your stools don't float you're not getting sufficient fiber. Readers had a field day with that remark and many wrote to me complaining that I'd given them a stiff neck.

Feces are normally brown. This is due to pigments formed by bacteria and bile from the liver. If there's bleeding from a cancer of the esophagus (foodpipe) or stomach ulcer the stool becomes black and tarry in appearance. But if bleeding occurs low down in the GIT due to hemorrhoids or a colon malignancy stools will become mixed with bright red blood.

People who develop a cancer or stone that blocks the common bile duct, which transports bile to the intestine, will notice pale or white stools.

But don't panic if there's a sudden change in the colour of the stool. Darkly pigmented foods such as blueberries or beets can change the colour. Iron pills and the bismuth in Pepto-Bismol can also darken stools.

The composition of stool is also dependent on the amount of fat consumed. Normal stool contains about one percent fat. Passing stools that contain seven percent fat creates a condition called "steatorrhea". These stools are soft, smelly and stick to the sides of the toilet bowl. This problem if chronic, is due to a lack of enzymes produced by the pancreas, or it may be temporary due to an extremely fatty meal.

How often should you have a bowel movement? Dr. Levitt says this is an individual matter. Some people have one to three movements a day. Others may be perfectly healthy with a movement every three days. Dr. Levitt stresses that constipation is not defined by the frequency of bowel movements, rather by the difficulty of having one.

The prime time to have a bowel movement is after breakfast . Getting out of bed immediately triggers an increase in bowel activity. Breakfast then expands the stomach that sends a stimulating message to the colon, called the gastrocolic reflex. The toilet is usually the next stop.

Delaying a bowel movement for a long time is never a good idea. But Dr. Levitt says a short delay is good as it causes a more intense urge and an easier bowel movement.

A bulky stool that's soft as toothpaste and floats has several health advantages. Soft stools pass through the colon more easily and quickly than stools as hard as rocks so there's less straining with bowel movements.. This means there's less chance of developing diverticulitis (small hernias in the colon) and decreased risk of hemorrhoids.

High fiber diets lower blood cholesterol. They also fight obesity, the nations number one disease. Fiber, apart from the vitamins and minerals it contains, has little caloric value and by filling the stomach it decreases the hunger reflex. And keeping thin there's less risk of diabetes, hypertension and heart disease.

I must admit I haven't had the courage to tackle this subject at a dinner party. But I'd love to hear the result from anyone who has the intestinal courage to do so this holiday season. And my apologies if readers develop a stiff neck.

W. Gifford-Jones M.D Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is:
Dr. Walker can be reached at

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