Season 4 Episode 1: Is My Poop Normal?
Welcome to Season Four of The Gut Show podcast! Today, we’re talking about what makes poop “normal” and what poop is actually made of. I’ll share how it is made in the body starting with the food you eat and then moving through the digestive processes, including the small and large intestines before you eliminate it from your body.
We’ll also touch on what makes poop brown and what can cause an issue with forming stool. Even more interesting, I’ll share how stool is stored and when it’s released, what happens when you sit down on the toilet and all the different forms your poop can take. Finally, we’ll discuss what it could mean if you’re pooping too much OR not enough. Basically, you have been enrolled in POOP 101 today! I hope you learn something new about yourself and you come away with a greater understanding of your health.
In this episode, we cover:
What is normal poop?
How does my food turn into poop?
Is it true that you aren’t what you eat, you are what you ABSORB?
Why are my poops different colors?
What if I have an issue forming stool?
How is stool stored?
What happens when I finally sit down on the toilet to poop?
What does it mean if my stool is not passing easily?
What’s the best posture for pooping effectively?
The seven different forms of poop – who knew?
What if you’re not pooping enough OR too much?
Don’t forget to connect to others in The GUT Community, a Facebook group for those with IBS and digestive disorders to support one another and dive deeper into each episode together.
We are back season four, The Gut Show is now live! This is the first episode and I am so excited to be here! This season is going to be really special, because we're going to be answering some of the top questions that were submitted through Google searches surrounding digestive disorders, like IBS.
To start, one of the biggest questions that I get asked from clients, and even those who maybe follow me on social media is this: is my poop normal? Now without me seeing your poop day to day, I do have the short answer. So TLDR, you can listen to only the first few seconds with this answer.
Normal poop is considered brown in color, like this (watch on youtube for visuals). A smooth form and texture, it passes easily and evacuate easily. It has a clean exit, and there's one to three of them per day. So if you were to check, check, check, check check, then you know that you have normal stool and normal poop and you can move on. But if you want to understand more about what makes poop normal, what makes it abnormal, and what you can do about it, keep listening.
Let's start first with talking about what poop actually is. So this is the makeup of your food leftovers from digestion, water, different organisms dead or alive, mucus that can kind of build up and be secreted as part of the digestive process in your body's health, and then old red blood cells that your body is kind of shedding and getting rid of.
The way that stool is actually formed is that food comes into your mouth, and then starts the digestive process. So it's coming in one form, we start breaking it down while we're chewing, and then as it moves through the digestive tract, it starts to change form and shape. So that first starts in the most major way in your stomach. Whenever your food is in your stomach, those digestive acids and juices, those are breaking down your proteins, it's starting to put it together as a bit of more of a mass. And this is more of a liquid mass versus a well formed mass that's moving through. So you're getting things kind of broken up, churned up and turned into more of like a liquid mass that's starting to move all as one.
The food combines with different liquids and different digestive juices that were secreted. And so that liquid mass isn't just food, that's where liquids come into play and those juices are going to travel along with you. Once that food leaves your stomach and moves into the small intestine, this is where we really start to break down those foods that you ate into macro and micro nutrients that your body can really break apart, absorb and utilize for overall health. So this is super important when we're thinking about optimal nutrition. We always say you know, you're not what you eat, you're what you absorb, this is where that's really happening and the power of that is happening in your small intestine.
Now, your small intestine is the longest part of your digestive tract, but food actually moves through pretty quick. As food is moving through your small intestine, you're absorbing, you're pulling out those nutrients and then that liquid mass of food is really starting to come together more and starting to take on a bit more texture to it versus like a clear mass or liquid mass.
Bile is also released in the small intestine as part of the digestive process, it's used to help break down, especially your fats. Along with this massive food, the bile that was secreted into the small intestine does make its way into the large intestine with the food. What's left from digestion, the small intestine will go into the large intestine for bacterial fermentation. So this is where we really get into especially carbohydrates and those non absorbable fibers that your gut microbes begin to ferment and produce gases from and all of those good things, that’s making it’s way into the large intestine, plus this bile that is traveling along.
As these things move through your large intestine, where it actually spends the most of it’s time, the food particles that your gut microbes have been trying to ferment, it mixes with that bile that has traveled that hasn't been reabsorbed, mixes with different water and liquids that are present, all of the undigested food particles that are there, bilirubin, which we're going to talk about more in a moment, dead cells and organisms. And these all form together to go from a liquid mass to a formed mass, which is known as your stool, which then is going to become the poop that you eliminate.
So this is also where the coloring of your stool comes into play! We're going to go over this in more detail in our bonus episode, why is poop brown, but that's really where the coloring of bile mixes with bilirubin, which is from those old red blood cells to give you that brown color that we're looking for, which can range from a really pale kind of dull brown to a dark brown. It will look different for each person based on what else is going on. Sometimes other colors will be present and this doesn't always mean that something is majorly wrong, but it does mean that something is going on that might be contributing to different colors and this is what we'll cover more in that bonus episode. So after you listen to this episode, go check out that bonus to get a better idea of what goes on with the coloring of your poop!
So the way that stool and poop is actually formed, and how it starts to come together after it leaves the stomach where it's churning up is through the process of peristalsis. So this is actually how food moves through the digestive tract as a whole. What's happening with peristalsis is that these smooth muscles of your digestive tract, which is really one long tube broken up into all these different sections, these muscles contract and release, contract and release, contract and release. And that helps move food along a little bit like if you had you know a balloon with a little bit of water in it and you wanted to move it to the other end, you would squeeze release, squeeze release, the same thing is happening throughout your entire gut. So the food particles and all of that mass that's coming through is kind of squeezing together and releasing and coming together as one, which is forming stool.
Whenever you have issues with forming stool, this could be due to a lot of different reasons. One big one is faster or slower motility linked to that difference in peristalsis. So if you have hyper motility, meaning food is moving too fast through your gut, what can happen is that you aren't forming stool properly, so it might come out more liquid, you may also not be completely breaking down that bile, so you may have weird coloring to your stool because things are just moving way too fast.
For some people, hyper motility can actually lead to undigested food in the stool, which isn't always abnormal, but could be a sign that things haven't been able to form or there was a poor breakdown process throughout the process of digestion because of that hyper mobility.
Now, if you're dealing with hypo motility, meaning that things are moving slower than they should be, this can actually cause more water in your stool that's there to keep that form in shape to be reabsorbed at a rate that we don't want. So overly reabsorbed from the colon into the body, and what that can do is leave your stool really hard and dry, which can make it lumpy, it can make it crack, it can also make it turn into these little pebbles that are very difficult to pass, contributing to this abnormal stool.
Some other reasons why we may not form stool include poor fiber intake: If you're not getting enough of those non digestible foods that do help add that bulk to the stool, then that can actually contribute to poor bulking and poor formation. Poor water intake can also be a reason and the reason is pretty obvious, if you don't have water that's contributing to that stool form, it's not going to be soft, it's not going to be as movable as it would be if it was well hydrated. And then another reason is low digestive capacity, and this could be due to malabsorption issues which could be celiac disease or other inflammatory conditions, poor bile release, which could be a gallbladder or even a liver issue. Even poor bile absorption where we reabsorb it in the colon, maybe there is poor enzyme release or poor secretion of your digestive juices. Any of this can actually lead to poor digestive function overall, which might contribute to poor formation of your stool. That can lead to poor coloring, so like the things that are contributing to the brown color aren't coming together like they should, or even the formation due to those carbohydrates and those different pieces that are supposed to come together.
Alright, so now that stool is formed, and it's made its way through your colon, what happens next?
So you're stool has to get stored and then released. The reason why stool storing it is so important is that you do not want to be releasing store all day long! Your colon, right at the end of your digestive system, it is constantly working. So food is moving through, and it can stay there for around 24 to 48 hours. So stool is moving and forming and moving and forming all day. If you didn't have good storage of stool, what can happen is that you may be pooping all day long, which is not normal and not what we want.
Instead, what happens is that we have a storage space of the colon called the rectum. And this rectum is right at the end and kind of a little bit of like a stomach or bean shape. or if you hold your hand and cuff, it kind of looks like that, were stool can kind of form a nice little holding place until you're ready to release it.
Right at the base of your rectum, you actually have a pelvic floor muscle called the puborectalis muscle. And this helps can kink off the bottom of that rectum so that you're not just emptying the rectum all day long, you can walk around and move your body, whatever you're doing with your day to day life, and not just be releasing stool.
Typically, the signal to release stool comes when that rectum is completely full. So it's putting pressure on those nerve endings right around where that muscle is kinking it off and telling your body hey, we're full, it's time to release, or when the gut is stimulated overall. So when you wake up, either upon waking or with the first bite of a meal, or with the first kind of big drink of water, your gut starts to turn on after resting most of the night. And what it does is it says hey, we're going to have food coming through, we're going to be creating more stool and so whatever is stored really needs to be released. And this can cause that urgency or that signal to your body that it is time to release stool for the day ahead so that I can form and store more stool.
Now not everyone gets this signal perfectly. So some people are going to get an over active or overstimulated signal. And that could be due to nerve issues, pelvic floor issues, it could be due to not releasing all of the stool that was stored in the rectum so it is constantly full, there's a lot of things that can cause kind of this overstimulated gut and an over signaling of this urge.
Some people will actually not get the signal or not feel that signal and so their rectum may be full, they may be ready to release stool, but they may not be getting that signal due to either nerve issues or even just ignoring the signal for too long. Your body is very sensitive to your communication. And I don't know exactly why this happens, but we know that whenever you ignore those signals your body gives you for hunger or fullness or even the urge to go poop, if you ignore it for too long, you are not going to get those same signals. And that's going to be disconnected which is going to lead to you not knowing that your rectum is full, stool is ready to be released and then you don't go and what that can do is cause too much of a buildup of stool in the rectum and in the rest of the colon which can lead to really bad constipation, and even less function or a weakness of those muscles, or it can lead to increased pressure on your pelvic floor which can lead to overflow diarrhea, other pelvic floor issues, hemorrhoids, things like that, that we do not want and are not considered quote unquote normal.
So when you actually get to the toilet, you're sitting on the toilet and you're ready to release stool, a normal passing of stool will mean that that puborectalis muscle is unkinked, and your rectum is elongated to fully release what's there and then all of the pelvic floor muscles surrounding the base of your rectum and your anus, the anus and the anal sphincter, these muscles will relax and the formed poop that is in your rectum will pass through easily, without pain or without discomfort and ideally without a lot of pushing or bearing down. If you're having to push and force stool out, that is where there could be something abnormal going on.
So some of the most common reasons why stool is not passed easily is the poor relaxation of those muscles. And so that can be due to tension that you're holding in your pelvic floor or tension throughout the rest of your pelvic floor, which many people will have issues with. It could be due to that poor connection, so there are some people who it's a brain connection, brain body connection of relaxation, it doesn't just happen naturally, for some people, they're not able to make that connection, and really connect to the right muscles to relax, so that can be an issue, or even chronic constipation, like I mentioned, where if we're not going, we're ignoring those signals, we’re putting a lot of pressure, those muscles will get very tense, and so they will not relax as well.
Another reason for poor release would be the poor coordination of your abdominal muscles that are used to actually push stool through. So like I mentioned before, you shouldn't have to bear down and push really hard in order to pass stool. That is not normal. What you should be doing are these abdominal muscles kind of around your core, those deep muscles, they're actually involved in helping push and move stool out. And so with the right breath work and coordination of these muscles, you're able to push stool more effectively without creating a negative pressure on your pelvic floor. And this is a healthy release of stool. For some people, this is something that does happen pretty easily. For others, maybe if you deal with slower motility or issues evacuating stool, this could be something that needs a little bit more focus.
And the last reason which is probably the most common reason for poor evacuation of stool is hard stool, and that can be due to poor hydration, poor fiber intake or that backup, so not releasing it as frequently as we should.
In order to have really good evacuation of stolen pooping with more efficiency, your toilet posture really does make a difference. So with proper toilet posture, where your knees are above your hips, your diaphragmatic breathing is in place to help release those muscles and relax. And you're pushing with that inhale of breath using those abdominal muscles, versus your exhale, will all help you release poop more effectively. I have a lot of examples of this on Instagram @erinjudge.rd so if you're interested in an example of what this looks like, you can head over there or you can search online and find a lot of videos and great examples of what proper toilet posture should really look like.
All right, so going back to what is considered normal, we have a brown color, and remember, we go into more detail on this on that bonus episode. why is my poop brown. You have a smooth form and we're going to talk a little bit more about that next and how to know what a smooth form actually looks like to gauge where you're at, you pass it easily, which we just covered, there's a clean exit, which really has to do with those muscles and the formation of your stool, and you only go about one to three times per day. So you're going at least one today, anything less than that really isn't that normal, because again, that rectum is going to get too full and back up, which we don't want. And anything more than three per day needs might not be emptying as completely as we need to or there might be something that's stimulating an over activity that we really need to focus on, whether that be diet or lifestyle driven, or even just the autoimmune kind of piece of IBS and some of that complexity that we know is going on.
So now let's dig deeper into the form of soil and what it means to be smooth. The best way to gauge what the form of your stool is right now and what your body's communicating through your poop is the Bristol stool chart. So in the Bristol stool chart, we have type one poop, which is hard separated pebbles. Now these might be big, these might be smaller, this is going to look different for everybody and might change based on some of the things that are going on, but typically, these are a bit painful to pass and feel like you're trying really hard and it's just a little drop in the toilet. This is a major sign of constipation and a sign that things are not forming and moving as completely as they need to. Maybe you need more hydration, maybe it's fiber intake, that's really going to be personalized based on the full picture, but this is the clear sign that you are constipated and we need to focus on that.
A type two poop is going to be a lumpy mass, sometimes broken up sometimes all in one. So instead of it being these little pebbles, it's going to be a bit more lumpy. And what you can imagine by seeing this stool in the toilet is that this has been stored up in the rectum way too long and it's just getting bigger and bigger and bigger. This usually comes with a lot of pain in the gut, like you might have a lot of pain and cramping prior to the bowel movement, and it's usually going to be very difficult to pass. For some, depending on how hard it is, this can actually lead to these little cuts around the anus and the anal sphincter, which might even lead to bleeding and a lot of discomfort. And this is a sign that you're constipated and a sign that we probably need to work on evacuating that rectum more consistently. So it may not be that things are moving way too slowly throughout the colon, but we need to focus on that evacuation. And again, the rest of that picture will be fully personalized to you.
Now a type three poop is considered more normal. This is where we have a bit of a lumpy log, maybe with some cracks on it, so things are starting to form in a more complete way, could still be broken up, but it's a bit easier to pass. So there might be some mild discomfort, especially when you're starting to pass the stool, there might be some of that scratching depending on how hard it is, but usually it's easier to pass than a huge mass. This is a really clear sign that you need to focus on hydration and that passing of stool. So it may not be that things are really packing up and getting overly packed in, but it could mean that things are not soft and smooth like they should be, so adding more hydration will help pass that stool more efficiently.
The gold standard, which is a type four poop, and this is what we consider a smooth log or logs. This isn't always going to be just one perfect piece, it might be separate pieces and that is okay, but what we're looking for is at the edges and the surrounding of the stool is pretty well formed and smooth. How round or thin this is can vary. If it's too thin, that can be a sign that that anal sphincter is not opening properly. If it's really large, that could be a sign that maybe we need to be passing this a little bit more frequently. With this, this is considered normal, but can still give us a lot of information about what's going on, so it's something that we celebrate, but also keep an eye on to make sure it's consistent.
Still sort of on the normal side, but moving towards diarrhea, is a type five. This is where you're gonna get looser texture, kind of these formed blobs. It's not necessarily these lumpy pieces, it's a little bit more formed but not fully intact or even in a log formation, it's more like a blob in the toilet. Sometimes this is going to be mushy, but they're going to be at least clear cut, you're going to see some definition to them. So what this is saying is that the stool formation is a bit off and so that's something that we want to focus on. We want to focus on both proper elimination of stool just in case there is some constipation and this is the end of that where there's it hasn't been able to form because the rectum hasn't been cleared efficiently, or we may focus on fiber intake to really bulk up that stool and add better formation to it. Again, depends on the whole picture, but it can give us an idea of where to start and what to look for.
Now a type six poop is going to be that mushy kind of mass. This is one of our clearest forms of diarrhea or a clear out from constipation. Now if this is true diarrhea, this is happening often, this may come with a lot of urgency. It's also very common for period poops, which is also one of our bonus episodes this week, if you want to check that out and learn more about why this happens. But if you don't have that urgency, and it's coming out after days of not going, that's a pretty clear sign that you've been constipated, and things are just kind of pushing out. I like to call this explosion after a big backup, but you can call it whatever you want, you've probably experienced that at some point. Usually this mushy stool is also not going to be a clean exit and might be like mushy against your rectum and your anus it's just not going to be comfortable. So what we're going to focus on here is proper evacuation and healthy motility of the gut, good formation of stool and making sure that we are passing stool as often as possible so that this doesn't happen and build up, as much as we can control. Every now and then it might happen again, with period poops, more frequently, but it's not something that should be happening every day or even every week.
And now type seven, which is our standard for diarrhea, and that's a full liquid poop. Now this might be easy to pass and not feel like it's going to be this urgent liquid diarrhea like situation, but it also could come with that urgency. So what I want to ask here is if you are dealing with a type seven poop, is how much output is in the toilet? Are you releasing a ton of stool or is just a little bit that's liquid? If it's a ton of stool, and you're going frequently, more than three times in a day, that is a sign of diarrhea and that means there's something going on we need to figure out. It could be that you have some diet triggers, it could be that there's increased intestinal permeability, maybe there's an infection, maybe there's a bacterial overgrowth or imbalance we need to address, but whatever the cause there's diarrhea, and we need to work on it by slowing down that motility, addressing the problem, and then improving stool formation and all those other pieces we talked about.
Now, if you have a type seven poop, but there's not a lot of good output, so if you're only going a little bit, especially if you're having to push and try to force it out, and you're not easily passing it, that could be a sign of overflow diarrhea, which is actually constipation. So remember that rectum I talked about where that stool is forming and building up, imagine if that's full of stool and it's backing up into your colon, and more stool is trying to get through, if it's liquid, because it hasn't had a chance to form yet due to that backup, it can make its way around the backup store and come out as liquid, which is considered overflow diarrhea. In these cases, what we need to do is actually clear that backup and get the bowels moving again. This can be very uncomfortable for those who are living with this and so getting professional guidance, someone that'll help you walk through those steps is really helpful so that you don't feel like you're causing more diarrhea, or you're not exactly sure what you're working on and what your expectations should be.
Alright, so now for the normal one to three bowel movements per day, what happens if you're not going enough? So if you're not going daily, or you're going more than two to three to four days apart, this is really linked to poor motility overall, so that poor peristalsis throughout the entire tube of the GI tract, poor toilet habits where we're not actually creating situations where you can go or not listening to those signals, maybe there's poor form, poor posture on the toilet, or poor evacuation, and that could be due to pelvic floor dysfunction, or issues connecting to relax those muscles, which can all be addressed and fixed. If you're not going enough, there might be a few pieces at play that we need to work on and there might be a multidisciplinary team like a pelvic floor physical therapist, a GI doctor and a dietician to help you get to that daily bowel movement that you're looking for.
Now, if you're going too much, you're going more than three times a day, this can be due to increased motility, which might be linked to stress, nerve issues, maybe some diet or lifestyle triggers. This could also be linked to infection, especially if this came out of nowhere and it's more acute, meaning it's not lasting as long, that's that can be common and something that we may experience. Or it can also be due to SIBO, small intestinal bacterial overgrowth. I don't always want to jump here, but this is common in those with IBS D, diarrhea predominant IBS. What happens is that there's an overgrowth of hydrogen producing bacteria in the small intestine, and then there's hydrogen sulfide producing microbes in the small or large intestine that will eat that hydrogen and can contribute to hydrogen sulfide release and diarrhea. If this is happening, and it's been building up over time, that's something that we may assess, and try to address if it's present, to make sure that we're attacking it from the right angle.
Now, I didn't really talk a lot about how your poop should smell, because this really depends on what you're eating, how fast you're going, your own body, all of these different factors. But if your poop is smelling very foul, and this is happening daily, that is a signal that something is off and this isn't really normal. So some of the reasons for this could be that hydrogen sulfide production that I mentioned with SIBO, and that'll smell like sulfuric gas, you'll kind of recognize that smell pretty quickly. It can be due to constipation if you have stool backing up for too long, this creates a huge kind of salad bar, if you will, for your gut microbes, and they're gonna eat on that fiber and eat on those little particles producing even more gas, that can kind of smell like rotten food, which is really gross to think about, I know, but it happens to everybody.
It could be a carbohydrate intolerance, like what we see with lactose intolerance or fructose intolerance, very common when carbohydrates are not fully absorbed or broken down and they make their way undigested into the large intestine. This can lead to diarrhea for some, but it can also lead to some of that foul smelling gas or poop. And then fat malabsorption, same thing, if those fats aren't broken down, they can make their way into the large intestine in a form that they're not meant to be in and that can come out through your poop and contribute to foul smell that you don't want.
And then for the colors that aren’t brown again, if you're interested in this piece, please go over to our bonus episode why is poop brown because it's gonna go into this in more detail, but know that the color of your poop can change based on the foods that you're eating, and any liquids, especially those with like food coloring or dyes, it can change based on medications or supplements and then sometimes it can indicate a bigger problem and a concern, which is why you want to go check it out.
Now, if you are new to learning about your poop, I encourage you to open the toilet seat after you have a bowel movement, or stand up and turn around and look at the poop that's in the toilet bowl before you flush. You don't have to take pictures or do this every single day, but doing this brief in a short amount of time to really understand what communication your body may be giving you is so valuable. And it can also help to track that pattern and track what you're seeing, so that you can begin to put correlations together and see what is going on.
If you need a resource for this that's designed for those with digestive issues and those who are dealing with some of these digestive concerns My Gut Journal, which has a 90 day logging tool that I created for those with IBS and digestive disorders is a great resource that you can use. If you're interested we do ship throughout most of the world, so it is a good option. Or you can use an app on your phone or anything that connects with you.
Thank you again for tuning in, I'm so excited that we've officially kicked off the season and I can't wait for more that's coming throughout the rest of this season!