As mentioned last week, individuals rarely look at their urine. However, looking at stool or bowel waste is quite another thing. People look at their stool, especially if they sense a difference when toileting or performing a bowel program. Looking at your stool can indicate issues, not necessarily cause for alarm unless there is blood present.

One of the first issues with stool is the color. These are some normal and not-so-normal stool colors.

The color of the stool should be a mid-shade of brown. Tan stools or a very light brown typically indicate more protein is needed in your diet.

Greenish stools can be from food. Undigested food typically will produce particles of food of various colors in the stool; corn is a common example. Spinach and kale are culprits for a fully green stool. Medications that can turn stool green are iron supplements and some antibiotics. Read the medication package insert to see if this is a side effect. Stool moving too quickly through the bowel or liver and gall bladder issues can leave a green tinge to stool.

Yellow stool that is greasy and smelly is a sign of too much fat in the waste. It develops from difficulty in food absorption, decreased enzyme or bile production, or temporarily from eating too much oily food.

The orange stool is most often from overeating carrots and sweet potatoes. Medications that can make the stool orangish are antacids and rifampin. In addition, blocked bile ducts can result in the orange stool.

Red stools can be from food heavy with red dye (like in jello), tomato soup, or beets. Bright red stools are indicative of blood. Red streaks on the outside of stool can be from hemorrhoids, polyps, or fissures in the bowel. Red throughout stools, especially inside the stool, is indicative of bleeding higher up in the bowel. Bloody stool is a flag to phone your healthcare professional. Frank bleeding from the rectum is time for a healthcare visit or if extreme, like a large ‘whoosh’ of blood, means internal bleeding is happening right now, call 911. Bleeding from the bowel can be a sign of problems anywhere along the digestive tract. For example, it can be a sign of issues in the esophagus, ulcers, diverticulitis, inflammatory bowel disease or cancer.

Black stool can be from bismuth medications, iron supplements, or heavily dyed dark foods like licorice. An excessive amount of blood in the stool can make it look black. Stool that looks like black coffee grounds is a sign of bleeding. Helicobacter Pylori (H. pylori) is a stomach bacterium that can produce a black stool. Time for a call to your health professional.

The white stool is most often a result of antidiarrheal medication.

The next issue that most people wonder about is if their stool floats or sinks in the toilet. This was a fad several years ago. The flat answer is stool floats or sinks, depending on your diet. A stool that floats in the toilet can indicate a healthy diet full of fiber. This is often seen in individuals who use psyllium products. It can also be the result of a lot of gas contained within the stool.

On the other hand, it can be the result of too much fat in the stool. A stool that sinks to the bottom of the toilet usually means you need to add fiber to your diet. You do not need to worry about floating or sinking stool unless it is combined with other issues such as changes in color, abdominal pain, blood or other unusual symptoms or events, like diarrhea or constipation.

The Bristol Stool Chart is a visual image of what stool consistency should look like. It ranges from constipation (Type 1) to diarrhea (Type 7) with normal stool in the center (Types 3 and 4). Use of the terminology gives you the ability to relay your bowel concerns to your health professional in a clear and less embarrassing manner. There is even a free app for it. The app helps track your bowel results over time to notice changes or improvements. There are other free apps to track your bowel program as well.

Most people know the difference between constipation and diarrhea. Constipation is dry, hard stool. This should not be confused with neurogenic bowel, which is an issue with nerves propelling the stool through the bowel, with the ability to release stool out of the body, and with rectal sphincters opening appropriately. Because of slow-moving stool through the bowel (called peristalsis) due to neurogenic bowel, stool can become dry and hard, which is constipation. An individual can have neurogenic bowel with no constipation or a neurogenic bowel also with constipation. Constipation in the neurogenic bowel can be intermittent.

Treatments are available for neurogenic bowel, which includes bowel programs. For those with upper motor neuron injury or trauma or disease in the cervical or thoracic vertebral areas, a bowel program every other day using a suppository and digital stimulation is done. The UMN bowel is reflexive, which means that tone (spasticity) is present. Stimulation of the bowel with a suppository or mini enema will trigger the bowel to start moving. Digital stimulation will further enhance bowel evacuation and relax the internal and external sphincters to relax, letting the stool pass out of the body.

Lower motor neurogenic bowel (LMN) occurs with trauma or disease affecting the lumbar or sacral levels of the spinal cord. This type of bowel does not stimulate as tone (spasticity) is lowered. Bowel elimination is from gentile removal of stool using a gloved, well-lubricated finger. This removes stool from the lower bowel. Some individuals will perform manual removal every other day, daily or more frequently to maintain continence.

Individuals with neurological injury from the disease may have a UMN or LMN bowel or just a slow-moving bowel from inactivity or difficulty in getting proper nutrition, from obtaining food, putting food into the body, or chewing. Getting the right diagnosis of bowel issues is critical to using the best bowel treatment for evacuation.

Regardless of the source of bowel issues, everyone should pay attention to their diet to ensure enough fiber or roughage so the bowel has something to move along. Avoid foods that irritate your bowel, like caffeine, alcohol, and chocolate, or add foods that assist with peristalsis, like beans. Hydration, especially with water, will help constipation as the stool lingering in the bowel will dry out as quickly, resulting in constipation. Medications can help bulk up stool, coat it for smoother exit, and assist peristalsis.

Mobility is a critical element in bowel function as a movement of the body, especially the legs, moves the abdominal muscles, increasing peristalsis function or the ability to move stool through the bowel. If you cannot move your legs, have someone move them for you. A little movement goes a long way to help the bowel. Gravity is another feature of bowel elimination. Sitting upright helps drop stool out by use of gravity. Hey, gravity is there. This is one time to use it to your advantage.

Diarrhea is liquid stool. Often individuals have loose stools, which they term diarrhea, but diarrhea is liquid stool. This develops from stool moving too quickly through the bowel. It most often is temporary from illness, bacteria or even anxiety. The use of the BRAT diet will assist with clearing up temporary diarrhea. This consists of Bananas, Rice, Applesauce, and Toast. If it continues, check with your health care provider about treatments. You could have a disease or blockage causing the issue.

C. difficile (C diff) is a bacterial infection that affects the large intestine. It most commonly appears after taking antibiotics that have reduced the natural flora of the gut but can appear at any time. It can have no to few symptoms or lead to a severe case of diarrhea (more than ten episodes/day). C diff can even become life-threatening. Damage to the bowel can result. It has a unique smell. The stool may have a greenish appearance. This is a time to call your health professional for immediate treatment.

Most individuals forget about anxiety as a source of diarrhea. Being worried or anxious about something is a common source, however, do not forget those pleasant activities can have the same effect on the bowel. Going to a new job, school, even to a new healthcare provider may seem fine in your mind, but your body can still react to unknown situations. Of course, the worry about having a bowel accident is one of the most common reasons for having a bowel accident. A bowel program greatly reduces or even eliminates this concern.

Stool has an odor; after all, it is waste from the body. If the smell of your stool becomes stronger, you could have a bacterial infection in the bowel. Stool containing old blood also smells strong. This could be from a bleed within your bowel. You will recognize the usual scent of your stool. A huge change can be an indication of a problem in the bowel. Nurse Linda

Pediatric Consideration:

Babies with yellow stool is an indication of being new to the world or breastfeeding. Take note of your baby’s stool. As children begin to consume food, the more traditional brown color will appear. A change to other colors can be indicative of an issue as with adults.

Neurogenic bowel with constipation may not be seen if your child does not have results from their bowel program. The constipated or hard stool may create an impaction that will require medical assistance to remove. If this occurs frequently, you will be taught how to remove the stool, but a better management system to keep the stool soft should be used, either adjusting fluid, diet or adding stool softening or fiber medications. Be sure to check with your healthcare professional for the right treatments for your child’s unique needs.

Diarrhea occurs more frequently in children, especially when adding new foods or just a change in diet or routine. Remember, the bowel responds to changes in novel situations such as a new school, teacher, caregiver, or friend. Dehydration or electrolyte imbalance can occur more easily in children. If diarrhea is frequent, check with your health care provider for treatment. In some cases, IV fluids may be required. Nurse Linda

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the "how-to" on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.

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