What different colors and consistency of stool can mean to your patient's health. What is an intestinal emergency?

Shit From Shinola, Poop Color Theory, & Differential Diagnosis

"Shit. Shinola!"

Shit From Shinola, Poop Color Theory, & Differential Diagnosis

September 10, 2022

More than 40 years later, one of my all-time comedy film moments is from “The Jerk” starring Steve Martin. The moment comes when Martin is about to leave the farm for The Big City and Richard Ward (playing his father) shows him some animal excrement, comparing it to a can of Shinola shoe polish, explaining the difference. Ward proclaims his son “alright!” when he can tell the difference between “shit and Shinola”. 

Depending on your age, you may not be familiar with the saying, “You don’t know shit from Shinola!” It’s an old American saying, originated during World War II in the army barracks. Shinola was a brand of shoe polish. It means that a person who doesn't know “shit from Shinola” is very stupid. Maybe I’m just easy to entertain, but I still chuckle thinking about it.

However, knowing something about the color of what more refined nurses like to call a “BM” (bowel movement) or “stool”, can indicate what might be going on with a patient. When reporting to a physician, it can be a clue to help with a diagnosis. My classification of “poop color theory” is by no means inclusive and as with anything you read recommended by Dr. Google, you should do your own due diligence. The following is my own understanding from informal research and experience.

According to the National Institutes of Health, “The health of your gut plays a key role in your overall health and well-being.”

Stress, genetics, and diet can all affect gut health. Gut bacteria may even have an impact on certain medical conditions, such as allergies, asthma, colon cancer, Irritable Bowel Syndrome, obesity, rheumatoid arthritis, and type 2 diabetes.

According to Dr. Octavio A. Vega, a physician at Rush University Medical Center, Chicago, the ideal stool “…is like a banana.” Stools should have a soft consistency, round shape, smooth surface, and tapered ends.

It is important to discuss any changes in bowel movements with your patient. While diet can explain some unusual stools, other types of stool may be a sign of a serious health condition.

BLACK stool when temporary, can be caused by over-the-counter medications such Pepto-Bismol or Kaopectate (those containing bismuth subsalicylate), iron supplements (also cause constipation), blueberries, licorice, and other dark foods, spinach and dark greens (contain iron), NSAIDS and aspirin (can cause intestinal bleeding). 

More ominously, it can stem from bleeding in the upper gastrointestinal tract coming from the stomach or small intestine. It may have a strong odor, sometimes like iron (blood).

BROWN - MEDIUM TO DARK is the color of normal adult stool. Foods, diseases, and medications can alter its color and odor. 

BROWN - VERY LIGHT can be a sign of constipation, liver issues, or fat not digested. 

BROWN – PALE, CLAY, LACKING COLOR can indicate barium from a recent barium enema, antacids containing aluminum-hydroxide, consuming large amounts of Kaopectate or Pepto-Bismol (which can also turn it black – go figure!). It can also indicate problems with gall bladder, hepatitis, pancreatitis, and parasitic infections, among others.

FUN FACTS ABOUT CORN, CARROTS, CEREAL, AND NUTS: When you see remnants of these foods in stool, this is completely normal. The starches in these foods can be difficult to digest. Because these foods pass through the body virtually unchanged, it doesn’t always absorb all of their nutrients. “Almost all plant-based foods contain complex carbs that are not easily converted into calories by our bodies,” says Daniel Freedburg, M.D., a gastroenterologist at NewYork-Presbyterian/Columbia University Medical Center. Try steaming vegetables, softening them, and allowing more of their nutrients to be released. Also, chew foods thoroughly, this makes it easier for digestive enzymes to work on the food, so they are broken down and nutrients extracted.

Some nuts and seeds have tough exterior shells that make it difficult to extract the fats stored inside. Corn may not have a hard shell, but each kernel of corn has an outer casing made of cellulose, which cannot be broken down by human enzymes. The interior of the kernel gets digested, but the cellulose casing can still be seen in the stool. While it may look like the corn is undigested, its nutrients are still absorbed.

GREEN can be caused by artificial food color, medications, supplements, green foods (e.g., spinach, lettuce), gastroenteritis, ulcerative colitis, Irritable Bowel Syndrome, Chron’s disease, malabsorption, iron not absorbed from the body (because too much was taken), diarrhea, laxatives.

ORANGE can be caused by liver issues; eating anything with artificial orange food coloring; food passing through the body too rapidly to have been exposed to bile, medications or supplements containing beta-carotene or aluminum-hydroxide, consuming carrots, or tomato sauce.

RED – MEDIUM or BRIGHT may be because of consuming foods with a concentration of red food dye, beets, rhubarb, radishes, red vegetables and fruit, tomato juice, red gelatin, red popsicles, or red Kool-Aide type beverages. Also, hemorrhoids, ulcers, polyps, a sign of bleeding in the lower gastrointestinal tract, and an excoriated anus, to name a few.

RED – DARK or BROWNISH CRIMSON may be because of consuming foods with a concentration of red food dye, beets, rhubarb, radishes, red vegetables and fruit, tomato juice, red gelatin, red popsicles, or red Kool-Aide type beverages. In certain individuals, foods that normally turn medium red turn it to a dark red. Also, bleeding in the lower gastrointestinal tract, colon cancer, diverticulitis, gastritis, hemorrhoids, Irritable Bowel Syndrome, polyps, and ulcers, among other things.

FUN FACTS ABOUT STICKY STOOL:  Sometimes caused by improperly digested food due to celiac disease or an infection which can cause thick and sticky, abnormal looking stools. This type may be hard to flush.

WHITE can indicate consumption of antacids containing aluminum-hydroxide, barium from recent barium enema, or biliary obstruction.

YELLOW can be caused by the usual culprits - carrots or foods with artificial yellow food coloring. But there are many other, more serious causes like Gilbert’s Syndrome, jaundice, pancreatic cancer, malabsorption, and giardia, just to name a few. When the stool appears oily with a funky odoriferous aroma it can mean pancreatic problems. 

What about…

CHRONIC CONSTIPATION signs and symptoms include: feeling as though there's a blockage in the rectum that prevents bowel movements or can't completely empty the stool from the rectum, fewer than three stools a week, lumpy or hard stools, needing help to empty the rectum, such as using hands to press on the abdomen and using a finger to remove stool from rectum, straining to have bowel movements. Some things that can cause prolonged constipation are certain medications like narcotics and antihistamines, consuming large amounts of unhealthy junk food causing major damage to the digestive system, and a diet low in fiber, fried and processed foods, and excess dairy products. Alcohol and caffeine consumption results in dehydration which in turn contributes to constipation

ABSENCE OF or STRINGY STOOL  can indicate a more serious underlying problem, such as blocked intestines, abdominal adhesions, or small bowel obstructions. Symptoms can include prolonged constipation (7 days or more), vomiting, painful bowel movements, absence of bowel sounds, stomach cramps, diarrhea, abdominal distention, tenderness or pain, and inability to pass gas. This can be life-threatening and should receive immediate medical attention.

ANY NORMAL STOOL DEVIATIONS that can't be attributed to an obvious cause, such as concentrated food coloring, yesterday's meal, known medication side effects (except in the case of prolonged narcotic use), and is not a passing event, should be reported.

©2021 Guiomar Goransson