Strange faeces

Dr Margaret [biog] answers users' embarrassing problems in this problem page feature (new products every 2 weeks

Happy New Year! Variety is said to be the spice of life, so this year we’ve invited some new contributors to write for the Doc Spot. We begin with a series about strange bodily goings on by Jonathan Belsey and Alison Martin, and hope that increased understanding will prevent the embarrassment that many of us encounter when our bodies don’t do what we expect them to.

Dr Margaret

What are faeces?
Faeces are made of water, bits of food that could not be digested, dead cells from the lining of the intestines and dead bacteria - all the solids that the body doesn’t need or want any more. They are brown in colour because of bile from the liver, but are darkened by iron and pigments in foods and red wine.

My baby has green poo!
Some parents are alarmed when their newborn baby passes sticky, dark green faeces in the first few dirty nappies. This is completely normal, and is called meconium. This is made in the baby’s bowel before birth when he swallows and digests the proteins in the fluid that surrounds him in the womb (amniotic fluid). Although the unborn baby passes urine into the amniotic fluid, he doesn’t usually open his bowels, so the meconium stays put until after birth. However, if the baby becomes distressed or short of oxygen during birth, his bowels will open. The amniotic fluid becomes green, and is a signal to the midwives and doctors that they need to get the baby out quickly. After these first few days, breast-fed babies produce runny, yellow-brown faeces, and bottle-fed babies have more solid, darker brown faeces. Infants fed on banana mashed with a fork may appear to have black worms in their faeces from the fibres

My faeces are black
If the bowel has a lot of iron-rich material in it, the faeces tend to be dark brown or black. This can happen if you are taking iron tablets, or have eaten a lot of red meat or black pudding. It can also happen if the upper part of your intestine is losing blood -this blood is digested further down the intestines in the same way as food. Such bleeding can be due to an ulcer, irritation of the stomach from taking drugs like aspirin and ibuprofen, or tumours. If a lot of blood is being lost into the intestines, the faeces become black and sticky, like tar. These symptoms should be reported to your doctor urgently so that you can be treated before the blood loss becomes too severe. The reason for the bleeding can also be investigated.

Red blood on the faeces
A common cause of seeing red blood streaked over the faeces after opening your bowels is piles (see Piles). These are swellings round the anus that contain blood, and are common in women who have had a baby or in people who tend to be constipated. They can be painful or itchy. The skin over the surface of the piles is thin, so they bleed quite easily, although this is rarely more than a drop or two. Occasionally, blood on faeces can indicate bleeding in the bottom part of the bowel, which may be due to a tumour. If you have this type of bleeding, it is wise to see your doctor, particularly if you are over 50. Piles can be treated. They can be injected with a chemical to make the blood inside them clot or removed surgically. However, they do tend to come back. The best way to combat this problem is to eat a high-fibre diet, ideally with five portions of fresh fruit and vegetables a day, to keep the faeces soft.

My faeces are really smelly and won’t flush away
Normally, when we eat, food is digested by enzymes in the intestines. There are different enzymes for different types of food, and those that digest fatty foods are helped by bile made by the liver. Sometimes the bile or enzymes are not made or can’t get into the intestines because of a blockage. This means fat in the intestine can’t be digested, and so it passes through the bowel where bacteria feed on it. The high levels of fat and the waste products from the bacteria will make the faeces smelly, pale and frothy, and difficult to flush away easily.

Why does this happen? It can be due to a number of reasons. Coeliac disease, a condition in which you cannot tolerate protein found in wheat, can affect the intestines so they can’t absorb fat in the diet. In gall bladder disease, bile, which is normally stored in the gall bladder, can’t get into the intestine to help absorb fat. If your pancreas, which makes enzymes and insulin, isn’t working properly, fat won’t be digested. This can happen if you have chronic pancreatitis or a tumour in the pancreas. If you develop any of these symptoms, visit your doctor to see what is causing the problem. You may need to reduce the amount of fat in your diet or take tablets to replace the missing enzymes.

My faeces are very pale
Pale faeces following an attack of diarrhoea soon return to normal. They can also occur in jaundice - because bile can’t get into the intestines, the yellow colour builds up in the blood instead. Gall stones are often the culprit and are often associated with bad abdominal pains. However, the tube that feeds bile into the intestines may be blocked - this is not usually painful - or the liver may be inflamed (hepatitis). If your faeces become pale and your skin or the whites of your eyes turn yellow, consult your doctor.

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