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Time to talk about POOP

SUNDAY, JUNE 19, 2016.  DAY 10. When you end today, you’re officially over the hump!

You should be feeling over the hump by now.    Settling into a scheduled routine of eating, tracking…you’re starting to know what 4 or 8 ounces of meat looks like without weighing it, right? Alright!

So, it came early, but the question came up about poop this week.

One of the most common problems people have when starting this challenge is a change in poop.  You either “don’t” poop, poop a lot and too often (no long runs please!), or it’s just differently.  The increase in vegetables (hopefully), the decrease in “refined carbohydrates” and the increase in protein (which can cause you expel a little more water/fluid and force the need to drink more, which we don’t always do)…all known causes of pooping problems.  

Diane Sanfilippo’s book, Practical Paleo, is in the RebelHealth room.  There’s a great section on poop. It’s quite hilarious, and easy to relate to! Jump in there and check it out. Practical Paleo: a guide to your poop!

There’s actually a clinical chart, called the Bristol Stool Chart, from which this was likely based. Check it out:

BRISTOL STOOL CHART copy

Here’s how to interpret the poop type from the Bristol Stool Scale:

Type 1 has spent the longest time in the colon and type 7 has spent the least. Stools at the lumpy end of the scale are hard to pass and often require a lot of straining. Stools at the loose or liquid end of the spectrum can be too easy to pass – the need to pass them is urgent and accidents can happen. The ideal stools are types 3 and 4, especially type 4, as they are most likely to glide out without any fuss.

What type of stools are best?

* The feeling you need to go is definite but not irresistible * Once you sit down on the toilet there is no delay
* No conscious effort or straining is needed
* The stool glides out smoothly and comfortably

* Afterwards there is only a pleasant feeling of relief
* All this is most likely if the stool is Bristol Stool Form Scale, type 4

» Type 1: Separate hard lumps, like nuts

Typical for acute disbacteriosis. These stools lack a normal amorphous quality, because bacteria are missing and there is nothing to retain water. The lumps are hard and abrasive, the typical diameter ranges from 1 to 2 cm (0.4–0.8”), and they’re painful to pass, because the lumps are hard and scratchy. There is a high likelihood of anorectal bleeding from mechanical laceration of the anal canal. Typical for post- antibiotic treatments and for people attempting fiber-free (low-carb) diets. Flatulence isn’t likely, because fermentation of fiber isn’t taking place.

» Type 2: Sausage-like but lumpy

Represents a combination of Type 1 stools impacted into a single mass and lumped together by fiber components and some bacteria. Typical for organic constipation. The diameter is 3 to 4 cm (1.2–1.6”). This type is the most destructive by far because its size is near or exceeds the maximum opening of the anal canal’s aperture (3.5 cm). It’s bound to cause extreme straining during elimination, and most likely to cause anal canal laceration, hemorrhoidal prolapse, or diverticulosis. To attain this form, the stools must be in the colon for at least several weeks instead of the normal 72 hours. Anorectal pain, hemorrhoidal disease, anal fissures, withholding or delaying of defecation, and a history of chronic constipation are the most likely causes. Minor flatulence is probable. A person experiencing these stools is most likely to suffer from irritable bowel syndrome because of continuous pressure of large stools on the intestinal walls. The possibility of obstruction of the small intestine is high, because the large intestine is filled to capacity with stools. Adding supplemental fiber to expel these stools is dangerous, because the expanded fiber has no place to go, and may cause hernia, obstruction, or perforation of the small and large intestine alike.

» Type 3: Like a sausage but with cracks in the surface

This form has all of the characteristics of Type 2 stools, but the transit time is faster, between one and two weeks. Typical for latent constipation. The diameter is 2 to 3.5 cm (0.8–1.4”). Irritable bowel syndrome is likely. Flatulence is minor, because of disbacteriosis. The fact that it hasn’t became as enlarged as Type 2 suggests that the defecations are regular. Straining is required. All of the adverse effects typical for Type 2 stools are likely for type 3, especially the rapid deterioration of hemorrhoidal disease.

» Type 4: Like a sausage or snake, smooth and soft

This form is normal for someone defecating once daily. The diameter is 1 to 2 cm (0.4–0.8”). The larger diameter suggests a longer transit time or a large amount of dietary fiber in the diet.

» Type 5: Soft blobs with clear-cut edges

I consider this form ideal. It is typical for a person who has stools twice or three times daily, after major meals. The diameter is 1 to 1.5 cm (0.4–0.6”).

» Type 6: Fluffy pieces with ragged edges, a mushy stool

This form is close to the margins of comfort in several respects. First, it may be difficult to control the urge, especially when you don’t have immediate access to a bathroom. Second, it is a rather messy affair to manage with toilet paper alone, unless you have access to a flexible shower or bidet. Otherwise, I consider it borderline normal. These kind of stools may suggest a slightly hyperactive colon (fast motility), excess dietary potassium, or sudden dehydration or spike in blood pressure related to stress (both cause the rapid release of water and potassium from blood plasma into the intestinal cavity). It can also indicate a hypersensitive personality prone to stress, too many spices, drinking water with a high mineral content, or the use of osmotic (mineral salts) laxatives.

» Type 7: Watery, no solid pieces

This, of course, is diarrhea, a subject outside the scope of this chapter with just one important and notable exception—so-called paradoxical diarrhea. It’s typical for people (especially young children and infirm or convalescing adults) affected by fecal impaction—a condition that follows or accompanies type 1 stools. During paradoxical diarrhea the liquid contents of the small intestine (up to 1.5–2 liters/quarts daily) have no place to go but down, because the large intestine is stuffed with impacted stools throughout its entire length. Some water gets absorbed, the rest accumulates in the rectum. The reason this type of diarrhea is called paradoxical is not because its nature isn’t known or understood, but because being severely constipated and experiencing diarrhea all at once, is, indeed, a paradoxical situation. Unfortunately, it’s all too common. 

Here are a few good blog posts about poop and Paleo – it’s basic digestion, so grab your high school health class memory and let’s go!

The Poop Report.   How poop works:  Tour the factory.

Mark’s Daily Apple:  In search of a good poop.

 

 

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