Your bathroom habits say a lot about your health. Noticing patterns in your morning toilette helps predict future health issues, it could hold the secrets to help your patients live longer, healthier lives.

Frequency and appearance matter

Many doctors are familiar with the connections between how often and what kind of stool is passed and the risk of major diseases like cancer and heart disease. 

In the largest recent study related to going number two, Chinese researchers assessed the individual and joint correlations of stool frequency and consistency with all-cause and cause-specific mortality, using 2005–2010 US data from the National Health and Nutrition Examination Survey (NHANES).[1]

Researchers assessed faecal patterns in 14,574 participants over 7.6 years, during which there were 1,502 deaths (357 attributed to cancer; 284 attributed to cardiovascular disease [CVD]). In total, 50.7% of participants had a bowel movement 7 times/week. The most common form, described by 51.8% of participants, was labelled “like a sausage or snake, smooth and soft.”

There was a parabolic relationship between stool frequency and all-cause mortality; individuals who defecated fewer than 7 times/week were at increased risk of death (HR for 1 time/week: 1.43, P = 0.04; HR for 6 times/week: 1.05, P = 0.03). Additionally, 4 times/week of soft stool was correlated with 1.78-, 2.42-, and 2.27 times higher risks of all-cause, cancer, and CVD mortality, respectively.

“Infrequent soft stools were associated with a higher risk of all-cause, cancer, and CVD mortality, while regular or moderately frequent hard stools may contribute to a higher risk of CVD mortality,” the authors concluded. “These findings suggest that self-monitoring of stool frequency and stool consistency may be a simple yet useful tool for informing about major chronic illnesses.” They noted that public health education “should consider including similar bowel health evaluations.”

Useful stool tool

A literature review conducted by UK researchers revealed some shared characteristics about bowel movements.[2] They found that most people typically defecate 1.2 times in 24 hours. They also found that the main variable affecting faecal mass was fibre intake. In low-income countries—where people eat more fibre—the faecal mass was twice that of high-income countries. 

The Bristol Stool Form Scale (BSFS) is one of the most frequently used scales to analyze stool form and bowel habits and to predict intestinal transit. It is useful in evaluating patients with irritable bowel syndrome (IBS), GI disease, and stool changes secondary to medication use.[3]

According to the Cleveland Clinic, the most common reason for type 1 or 2 is dehydration.[4] The addition of increased fibre and exercise is helpful with decreasing intestinal transit times, therefore reducing constipation occurrence. 

Type 5 could indicate insufficient fibre, or it could be a signifier of bowel disease. Type 6 or 7 could represent infection, food poisoning, bowel disease, or chronic stress.

Faecal matter that is pencil-thin or difficult to pass might be a sign of colon cancer or small bowel obstruction. Suspicion is heightened when patients who used to have large bowel movements suddenly experience smaller ones.[5]

Navigating the color spectrum

Different colours of faecal matter could indicate the following:[4]

1. Green: Infection with a bacteria, virus, or parasite; this colour could also be due to IBS or medications 
2. Black: Upper GI bleed; less nefariously, a black colour could be due to taking iron supplements or bismuth subsalicylate (Pepto-Bismol)
3. Red: Rectal bleeding secondary to haemorrhoids, IBS, anal fissures, ulcers, or colorectal cancer
4. Yellow: Disorders of the liver, pancreas, or gallbladder; acholic stools refer to pale-coloured stools due to a lack of bile pigment. [6]

While you don’t want to be surprised by the colour of your movement, strange hues can sometimes be temporarily caused by the consumption of food dyes.[6]

Disclaimer: This story is contributed by Naveed Saleh, MD, MS and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.