Poop patterns portend mortality

Your bathroom habits say a lot about your health. Many doctors are familiar with the connections between how often and what kind of stool is passed and the risk of major diseases like cancer and heart disease. 

Frequency and appearance matter

In the largest recent study related to going number two, Chinese researchers assessed the individual and joint correlations of stool frequency and consistency with all-cause and cause-specific mortality, using 2005–2010 US data from the National Health and Nutrition Examination Survey (NHANES).^[]

Researchers assessed fecal patterns in 14,574 participants over a 7.6-year span, during which there were 1,502 deaths (357 attributed to cancer; 284 attributed to cardiovascular disease [CVD]). In total, 50.7% of participants had a bowel movement 7 times/week. The most common form, described by 51.8% of participants, was labeled “like a sausage or snake, smooth and soft.”

“Infrequent soft stools were associated with a higher risk of all-cause, cancer, and CVD mortality, while regular or moderately frequent hard stools may contribute to a higher risk of CVD mortality,” the authors concluded. “These findings suggest that self-monitoring of stool frequency and stool consistency may be a simple yet useful tool for informing about major chronic illnesses.” They noted that public health education “should consider including similar bowel health evaluations.”

Useful stool tool

A literature review conducted by UK researchers revealed some shared characteristics pertaining to bowel movements.^[] They found that most people typically defecate 1.2 times in a 24-hour period. They also found that the main variable affecting fecal mass was fiber intake. In low-income countries—where people eat more fiber—fecal mass was twice that of high-income countries. 

Stool is graded on an ordinal scale from type 1 (ie, hardest) to type 7 (ie, softest). Type 1 and 2 indicate constipation, whereas types 6 and 7 represent diarrhea. Types 3, 4, and 5 are considered healthy.

According to the Cleveland Clinic, the most common reason for type 1 or 2 is dehydration.^[] The addition of increased fiber and exercise is helpful with decreasing intestinal transit times, therefore reducing constipation occurrence. 

Type 5 could indicate insufficient fiber, or it could be a signifier of bowel disease. Type 6 or 7 could represent infection, food poisoning, bowel disease, or chronic stress.

Fecal matter that is pencil thin or difficult to pass might be a sign of colon cancer or small-bowel obstruction. Suspicion is heightened when patients who used to have large bowel movements suddenly experience smaller ones.^[]

Navigating the color spectrum

Different colors of fecal matter could indicate the following:^[]

• Green: Infection with a bacteria, virus, or parasite; this color could also be due to IBS or medications 

• Black: Upper GI bleed; less nefariously, a black color could be due to taking iron supplements or bismuth subsalicylate (Pepto-Bismol)

• Red: Rectal bleeding secondary to hemorrhoids, IBS, anal fissures, ulcers, or colorectal cancer

• Yellow: Disorders of the liver, pancreas, or gallbladder; acholic stools refer to pale-colored stools due to a lack of bile pigment^[]

While you don’t want to be surprised by the color of your movement, strange hues can sometimes be temporarily caused by the consumption of food dyes.^[]