Introduction

That’s right- you read the title correctly, and, whilst this topic may seem funny at first, it is actually an extremely important bodily function that we all do. We quite literally do it every day, there or thereabouts, but we’ll come to that later. The average person spends a whopping 92 days on the toilet in a lifetime, so we really should get used to hearing it, saying it, and talking about it, shouldn’t we? Yet, studies are still finding that people are embarrassed by the word ‘poo’, and that there is a large taboo associated with the topic. This embarrassment can actually have a negative effect on health.  Did you know there is a strong link between your poo and certain health conditions? For example, bowel cancer is currently the second biggest cancer killer in the UK, and 92% of people will survive longer if bowel cancer is diagnosed in its earliest stage.  But a recent study showed that one in five adults in the UK were too embarrassed to visit their GP with bowel cancer symptoms, including a change in their poo habits. This gives food for thought, and makes you wonder how different this statistic would be if more people talked to their GP about changes in their poo.  The impact of this taboo continues well into our old age, with faecal incontinence (not being able to control our poo) only being reported to a GP by as little as 10% of women who have symptoms.

So, let’s talk about POO so that we know what is normal and when we should talk to our GP. Let’s start at the beginning of life…

Babies

NEWBORN: Poo (meconium) is green/blackish & has a tarry/sticky texture and usually has no smell. After 2 to 4 days, the poo will be less sticky & become a lighter browny-green, as the baby has managed to digest either breastmilk or formula.

BREAST-FED: If a baby is exclusively breast-fed, the poo will have a mushy, creamy texture, with a sweet smell to it. There are many shades which are normal for bread-fed baby poo, but most common is yellow or green.

FORMULA-FED: In contrast, this poo will be less runny & is similar in colour and texture to peanut butter, varying in colour from light brown to dark brown to greeny-brown.

SOLIDS: Once a baby moves onto solid foods, the poo will become smellier, thicker and darken in colour.

Baby Poo: Healthy Variations vs When to see a GP?

Type of Baby Poo Healthy Baby Poo See a GP
Coloured poo (Black/Orange/Purple) Black spots in poo could suggest the baby is swallowing blood from cracked nipples, and is usually nothing to worry about. It can also be a result of taking an iron supplement, in which case is perfectly normal and healthy. Orange and purple poo is most likely because of the colour of the foods they are eating, such as orange after carrots or purple after beetroot! If the Mother has no cracked nipples, or not taking an iron supplement, see GP as soon as possible as could suggest bleeding in the digestive tract.
Food in poo There may be chunks of undigested food in the poo, which is perfectly fine and healthy as the digestive system is still developing. If there is consistently large chunks of food, it may be a good idea to see a GP to check their intestines are working properly.
Explosive poo It is normal for babies to do occasional explosive or runny poo. Several runny poos over 2 days that are green, yellow, or brown with no lumps could suggest diarrhoea, and is a good idea to see your GP to prevent dehydration and rule out any allergies or infections.
Pebble poo A baby’s poo which is hard and looks like little pebbles suggests constipation, and is normal in babies being introduced to solid foods. If this continues for several days, it may be worth having a chat with the health visitor to rule out any allergies, infections, or dehydration.
Mucus poo If a baby has mucus in their poo, which is greenish in colour and is streaked with shiny strings, it may just mean the baby has a cold. If this goes on for several days is a good idea to see the GP to rule out an infection.
Blood in poo It is normal for a baby girl to get a few specks of blood in their nappy a few days after birth due to pregnancy hormones stimulating a ‘false period’. Blood in a baby’s poo can suggest an irritated bottom from constipation or nappy rash, and is best to see a GP to rule out these things or anything else like infection, allergies or problems with the baby’s digestive system.

Children and Adults

In a nutshell, once a child is eating solid foods and their digestive system has adapted to this, their poo should be very similar to that of adults. In other words, you can relax, as from here on out their poo should more or less stay the same and should be easier to judge if it is abnormal.

Colour and Texture

Even so, sometimes, a visual aid can be useful, here’s a lovely ‘chocolate bar’ version of the famous Bristol Stool Chart, which classifies poo into 7 categories. We should all be aiming for types 3 or 4, with 1 suggesting constipation and 7 suggesting diarrhoea. If you are not sure what these mean, read on for definitions. This chart is great as it can be difficult (as well as unnecessary and inappropriate) to ask to see your child’s poo all the time as they get older. Therefore, having a visual aid can be a helpful way of asking them to describe it without feeling embarrassed if they notice anything peculiar.

   

In addition to texture, the colour of poo is very important. Often the changes in poop colour are down to what we have eaten, such as vibrant coloured fruits and vegetables or food dyes.  Take a look at our picture, it  could be a useful way to compare the colour of your poo to what is considered normal and when it is a good idea to see a GP.

Some Concerns

How often should we open our bowels and poo? Pooing anywhere from 3 times a day to 3 times per week is considered normal. Clearly, this is a huge range for frequency of bowel movements. What is important, is knowing your own body, what is normal for YOU, and noticing if any changes. As well as the number of times you poo, colour, consistence, and how you poo matters too – do you always have to strain and push hard? This may indicate a problem.

Constipation– We are constipated when we are finding it difficult to poo, possibly going for a poo less than 3 times a week, poo is often hard and dry, and we may be straining to push it out. We can have other really unpleasant symptoms when constipated too, such as; stomach ache, feeling bloated, feeling sick, passing a lot of wind, wanting to go but can’t. Dietary and lifestyle changes can help resolve or reduce constipation, and we have some great tips on this in Part 2. But sometimes, we need help from medicines, if changing the diet doesn’t do the trick, then you may need a laxative which you can buy from a pharmacy. You should see a GP if your symptoms are not improving with treatment, have unexpectedly lost any weight, feeling tired all the time, have abnormal coloured stools (see chart) or are regularly constipated.

Diarrhoea– this is a condition where you frequently have watery or runny poo, 3 or more times in one day. Usually, it caused by a virus or something we ate, and there is no need to see a GP as symptoms will pass after 2-4 days naturally. Diarrhoea can also be a result of anxiety, a food allergy, medication, IBS, or certain conditions including coeliac disease, IBD, or cancer. So, if the diarrhoea symptoms do not settle in a couple of days, or you have dark blood in your poo, you’re persistently vomiting, you’ve unexpectedly lost weight, you feel dehydrated, or have abnormal coloured stools (see chart) it is a good idea to see a GP.  In the meantime, make sure you drink plenty of water to avoid dehydration, and stay at home for 48 hours after the last episode to prevent spreading possible infection. Foods to avoid which often make diarrhoea worse include milk and dairy products, fried, greasy or spicy foods.

Faecal Incontinence– this is a condition where there is an inability to control your bowel movements.  Often you have sudden urges to poo that you cannot control, or sometimes leak poo, or soil yourself without realising you needed the toilet, or poo while you are asleep.  It is a good idea to see a GP if you are experiencing any of these.  These things can be more common as we get older, and can be treated through medicines, certain pelvic exercises, incontinence products such as pads, and surgery if other treatments do not help.  But, they can also be a sign of something else happening so see a GP.

Summary

So, now you know what a normal poo looks like, how it changes as we grow for a baby to an adult, as well as some healthy variations, some key definitions, and when you should see a GP.  Although this brings us to the end of Part 1, please be sure to read Part 2, for tips on how to achieve a healthy bowel, including advice on nutrition and exercise, where you can go for more information, and a chat about ‘toilet talk’. Happy pooing everyone!

Written By Holly Underhill, Student Dietitian, Birmingham City University

Reference available upon request.