Fashion magazines are often blamed for setting unrealistic standards of beauty for women. We come to aspire to the cover models' flawless skin, cinched waists and super-wide "thigh space" that are more likely the result of Photoshop or extreme dieting than a healthy eating or exercise regimen. But in my line of work, I encounter another source of unrealistic cosmetic expectations for my patients: the Bristol Stool Scale.
[Read: Toilets With Sex Appeal.]
At the heart of the Bristol Stool Scale's popularity is this little-discussed fact: Lots of people are quite insecure about their poo's appearance, deeming their "No. 2s" to fall short on any number of aesthetic dimensions. I get complaints about pencil-thin poos and fat, "fluffy" poos; "swirly" poos and poos that disappear in a cloud of brown smoke on flushing; poos on the looser side, "concrete" poo; poos that come out in multiple pieces instead of one long perfect "banana" shape; and poos that are studded with remnants of foods recently eaten or pigmented with their colors. I have learned that people have quite high expectations of their poo and tremendous fear about what it might mean when their poos don't fall within the prettiest numerical range on the Bristol Scale.
But before you embark on your own futile pursuit of poo perfection, I urge you to consider my following threefold poo philosophy, backed by years of working in a gastroenterology practice:
1. Few things that come out of the human body – if any – are aesthetically pleasing. When I was pregnant, I attended a childbirth preparation class. One of the most enlightening and beneficial components of the curriculum was a slideshow of just-born babies with all manner of "normal" appearances: from cone-shaped heads and white pimply faces to bodies coated in dark downy fur and faces splotched with purple marks. The takeaway: A newborn immediately emerging from inside his mother may not appear perfect by Hollywood baby standards (or frankly, even cute), but that doesn't make it abnormal.
So too with poo. A poo can take on a variety of appearances and still be considered normal. It can be all manner of shades – from orangey and dark brown to magenta or green from certain veggies or blue from artificially-colored foods and beverages. Chronically skinny poos generally reflect ano-rectal muscle straining rather than anything about your digestion. And a stool's texture is often indicative of how much time it spent moving through your colon and can reflect the balance of fiber in your recent diet: loosey goosey and shredded wheaty suggest lots of roughage (insoluble fiber) or a faster transit time, whereas formed, pastier "Play Dough" stools result from more starches and soluble fibers and a slower transit time. (Overtly hard stools often reflect inadequate dietary fiber.) Many women experience alterations in their bowel habits and in their stool's appearance throughout their menstrual cycle, which is also a normal phenomenon.
2. Corn adds character. As do beet pigments, quinoa grains and sesame seeds, for that matter. As I've written previously about fiber, it is by definition indigestible to humans. This means that plant fibers – from corn kernels and tomato skins to celery strings and seed coats – should show up in the stool. Seeing plant fiber in the stool does not imply that you're malabsorbing nutrients, nor that you lack sufficient digestive enzymes. (Remember: Humans don't possess any digestive enzymes for fiber!) Rather than fret about the fibers and pigments that add color and texture to an otherwise mundane poo, enjoy them as reminders of that delicious meal in your recent past.
[Read: Digestive Enzymes: Help or Hype?]
3. If your pooping isn't problematic, then your poo isn't problematic. Forget about its shape. Or size. Or how it compares to other poos you've spotted online. The best way to judge the quality of your poo is by how it contributes to your health-related quality of life.
• Can you pass a poo comfortably without pain, excessive straining or bleeding?
• Do you poo often enough that you don't feel bloated and uncomfortable – but not so often that you can't hold a steady job or keep social engagements because you're always in the toilet?
• When you have the urge to go, could you hold it in if there was a line for the loo?
If you answered yes to all of these questions, then who cares whether your poo looks pretty? As my gastroenterologist colleague often tells patients about their poo: "If it comes out like it's always come out and you feel good, there's no problem."
If you answered no to any of these questions, you may consider a change in your diet and an evaluation by your doctor.
Although no one's poo is going to win any beauty contests, there are a few instances in which a poo's appearance does raise red flags that something is amiss. The following developments should not be dismissed, and warrant a discussion with your doctor:
• A sudden change in your poo's habitual appearance. When it comes to your bathroom habits, sudden change is not necessarily a good thing – particularly if it was not accompanied by a significant change in diet. For example, if you normally have full, plump stools and suddenly they become chronically skinny, it's worth a conversation with your doctor.
• Seeing blood in the stool, whether bright red or black. Small amounts of bright red blood often indicate hemorrhoids but can also point to something more serious like colitis or colon cancer. It's best to let a medical professional evaluate it to be sure.
• Stools that are oily, malodorous or require multiple flushes to empty the toilet. These stools can be a sign of malabsorption and merit further evaluation by your doctor.
Hungry for more? Write to firstname.lastname@example.org with your questions, concerns, and feedback.
Tamara Duker Freuman, MS, RD, CDN, is a registered dietitian whose NYC-based clinical practice specializes in digestive disorders, celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.
Please note that the author cannot offer individualized medical advice to readers who contact her via email.