Your stool—a very basic fact of life—is a good reflection of your health. It provides insight into the quality of your diet and, potentially, may indicate certain diseases, such as cancer. While changes in bowel habits are usually not a cause for alarm, they can indicate potential issues. How can you tell if your stool is healthy, and when is it time to see a doctor?
Pascale White, MD, MBA, MS, FACG
In this Q&A, Pascale White, MD, MBA, MS, FACG, Director of the Gastroenterology Clinic, and Associate Professor of Medicine (Gastroenterology), Icahn School of Medicine at Mount Sinai, discusses how to monitor your bowel movements for potential problems, and offers simple tips on how to eat for better gut health.
How often should I be having bowel movements and what should they be like?
Every individual has their own baseline bowel habits, which are largely affected by diet and can vary in frequency for all of us. Here are some general guidelines:
- Some bowel frequencies can vary anywhere from three times a day to every other day.
- Healthy stool is soft formed, typically sausage-shaped, and should be easy to pass.
- The color is typically brown but sometimes varies based on what you eat. In some cases, color may indicate a potential health issue. For example, if your stool is very pale or clay-colored, it may be something you ate or could be a sign of liver disease.
What changes indicate I should see a doctor?
We all experience changes in bowel movements, and occasional changes typically do not indicate a problem. However, if you are experiencing a big change in your typical pattern, you should speak to a doctor, especially if you experience:
- Stool that is black and tarry or contains red blood (indicates potential internal bleeding, hemorrhoids, inflammatory bowel disease, or colon cancer)
- Hard pellet-like stools that are difficult to pass or will not pass (indicates constipation)
- Bowel movements that are completely watery (diarrhea)
- Stool that is pencil-thin or ribbon-like (indicates potential colon cancer, polyp, or other lesion causing narrowing of your large intestine)
What can I eat to ensure good colon health?
You should eat a lot of fiber—including fruits, vegetables, nuts, and legumes—which bulks up stool and keeps it moving along, and also produces substances your colon needs. Generally, you should eat 20 to 30 grams of fiber daily. Keep in mind that eating fiber (particularly insoluble fiber) may cause some bloating or loose stools, but it is generally well tolerated. You should also drink plenty of water to prevent constipation.
What foods should I avoid?
You should avoid red meat in general, which is high in fat and does not contain fiber, and especially processed meats, such as sausage, bacon, and deli meat. The process of curing and smoking meat generates carcinogenic compounds that can promote changes in the colon cells that can lead to cancer.
What are some easy ways to include more fiber in my diet?
Here are some simple steps:
- Plan your meals and prepare them in advance. For example, making overnight oats before bed is a great way to ensure you are getting fiber in the morning.
- Look for ways to make easy switches to what you normally eat. When eating out, get a salad, ideally one with dark, leafy greens, instead of fries. Instead of drinking fruit juice, eat the whole fruit.
- Swap white potatoes for sweet potatoes, which are higher in fiber, and leave the skin. Make sandwiches with whole grain bread instead of white bread.
- For a snack, grab a bag of nuts instead of a bag of chips.
- You may also find that food-tracking apps are a great way to ensure you are getting enough fiber and other nutrients every day.
What are some other ways to maintain good colon health?
Exercise, moderate your alcohol intake, and do not smoke. If you are over the age of 45, or are considered high risk for colon cancer due to health issues or family history, you qualify for a colonoscopy. The procedure not only screens for colon cancer and other potential issues, but also allows us to remove polyps that can turn into cancer. Stool tests may also help identify potential issues, though they are not as effective as a colonoscopy.