What should I do if I have concerns about my stool?

Evaluating Concerns About Stool

If you have concerns about your stool, you should first document your symptoms in a two-week diary noting stool characteristics, associated symptoms, and potential triggers before consulting a healthcare provider for evaluation. 1

Initial Assessment of Stool Concerns

• Document stool characteristics including frequency, consistency, color, presence of blood, mucus, or undigested food for at least two weeks 1
• Note associated symptoms such as abdominal pain, bloating, nausea, vomiting, fever, weight loss, or changes in appetite 1
• Track potential triggers including dietary changes, medications, stress, or recent travel 1
• Consider using the Bristol Stool Chart to objectively describe stool consistency 1

When to Seek Immediate Medical Attention

• Presence of blood in stool (bright red, maroon, or black/tarry) 1
• Severe, persistent abdominal pain 1
• Signs of dehydration (decreased urination, dry mucous membranes, lethargy) 1
• Fever above 101°F (38.3°C) 1
• Significant unintentional weight loss 1
• Recent onset of symptoms in individuals over 50 years old 1

Evaluation by Healthcare Provider

When you consult a healthcare provider about stool concerns, they should:

• Take a detailed history of your symptoms, including onset, duration, and severity 1
• Perform a physical examination, including digital rectal examination when appropriate 1
• Order appropriate laboratory tests based on symptoms:
  • Complete blood count to assess for anemia or infection 1
  • Stool tests for blood, pathogens, or inflammatory markers when indicated 1
  • Thyroid function, electrolytes, or other metabolic tests if clinically warranted 1

Common Stool Concerns and Management Approaches

Constipation

• Increase dietary fiber gradually (both through foods and supplements) 1
• Ensure adequate hydration 1
• Establish regular toileting habits and allow adequate time for defecation 1
• Consider over-the-counter osmotic laxatives (e.g., polyethylene glycol) if lifestyle measures are insufficient 1
• Avoid straining during bowel movements 1

Diarrhea

• Maintain hydration with oral rehydration solutions if diarrhea is significant 1
• Identify and eliminate dietary triggers (caffeine, alcohol, poorly absorbed sugars) 1
• Consider over-the-counter anti-diarrheal medications for short-term relief if not contraindicated 1
• Avoid dairy products temporarily if lactose intolerance is suspected 1

Fecal Incontinence

• Keep a symptom diary to identify potential triggers 2
• Implement scheduled toileting and pelvic floor exercises 2
• Modify diet to improve stool consistency 2
• Consider fiber supplementation to bulk stool 2

Special Considerations

• Persistent changes in bowel habits lasting more than 2 weeks warrant medical evaluation 1
• New onset of constipation or diarrhea in older adults requires thorough investigation 1
• Patients with a family history of colorectal cancer or inflammatory bowel disease may need earlier or more frequent screening 1
• Medications that commonly affect stool characteristics include antibiotics, opioids, iron supplements, and certain antidepressants 1

Diagnostic Testing for Persistent Symptoms

• Colonoscopy may be recommended for patients with alarm symptoms or for age-appropriate cancer screening 1
• Specialized tests like anorectal manometry or transit studies may be needed for persistent constipation 1
• Stool culture, ova and parasite examination, or C. difficile testing may be ordered for persistent diarrhea 1
• Fecal elastase testing can help diagnose pancreatic exocrine insufficiency if suspected 1

Remember that most transient changes in stool characteristics are benign and related to dietary changes, stress, or minor infections, but persistent changes should be evaluated by a healthcare provider.