Take a look before you flush the toilet

Readers tell me they often discuss my column at dinner parties. But at this festive time of year I doubt that will happen with this column. Today, it’s Course 101 on poop. So, why would you want to look into the toilet before flushing it? It could save your life. But it might also scare you half-to-death.

A look into the bowl after a bowel movement has this advantage. Eventually, you learn that a normal stool is generally brown, usually the shape of a banana, and soft. This means you’re eating the right amount of fiber. Stools are about 75% water. And fiber, by holding onto water, makes stools as soft as toothpaste.

But suppose the colour changes? A black tarry stool may mean there’s been bleeding into the bowel. But before a series of tests are done, ask yourself whether you’ve been eating blueberries or beets. Or, is the dark colour due to medicine containing bismuth, such as Pepto-Bismol, for an upset stomach. But if the black stool actually contains blood, prompt treatment can save your life.

If the colour of a BM is pale clay, this is more of a problem. Bile produced by the liver and stored in the gallbladder causes the brown colour of the stool. A clay colour indicates a blockage due to a stone in the common bile duct that carries bile to the intestine. Or, it can be due to cancer of the pancreas.

Many patients have asked me why their stools have changed in thickness. If the stool is thin now and then, this is normally not a problem. But, if there are repeated pencil-thin stools, there may be a blockage in the rectal area due to malignancy, previous radiation treatments or colitis.

The composition of stool is also dependent on the amount of fat consumed. Normal stool contains about 1% fat. Passing stools that have more fat creates a condition called, ‘steatorrhea’. These stools are soft, smelly and stick to the sides of the toilet bowl. If the condition is chronic, it’s due to a lack of enzymes produced by the pancreas. It can also occur if you‘re taking Xenical, a prescription drug for weight loss. Or, if you have eaten an extremely fat meal.

In the event you notice a small amount of mucous in the stool, this is not a problem and is due to the jelly-like substance found in the bowel. But if there are large amounts, it could be due to inflammatory bowel disease, such as colitis. Or, to a mucous secreting intestinal polyp.

Let’s hope you don’t have very frequent watery, mushy stools and a fever after taking a long course of antibiotics. This may have upset the normal balance of bacteria in the intestines allowing a bacteria, Clostridium Difficile, to flourish. Such patients can have up to 40 bowel movements a day and sometimes a fatal outcome. Treatment by alternate antibiotics may be helpful. But as I reported in an earlier column, fecal enemas from another person may be used in desperate situations.

A quick gaze in the toilet bowl may scare some people to death. That’s when they notice Ascaris lumbricoides, which has the appearance of a garden worm. Today, we live in a wormy world and you don’t have to visit underdeveloped countries to pick up this infection.

Millions of dogs, cats and other animals are now sharing close quarters with North American families. Animals have to defecate somewhere and it’s often in the backyard or playground. One study showed that of 229 family dogs, 189 had roundworm, hookworm, tapeworm or other parasites. People who swallow a parasite egg can later pass a foot long worm.

If, during the holidays, you see your host running his hands down his beloved Fido’s tail, politely say ‘no ice’ before he picks up ice for your drink. Fido never washes his tail after defecating.

This decision may prevent your hair from standing on end. And I hope you don’t get a stiff neck from looking into the toilet bowl.

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