(upbeat music) Howdy, y'all. Welcome to our Let's Talk About Poop Podcast, where I go into a deep dive about a topic you guys ask about. We do some other videos and other topics as well related to the GI health. If you're watching for the first time, I'm Dr. Islam. I'm a board certified gastroenter, I'll just train at the Mayo Clinic. I have 10 years of treating patients with all sorts of GI issues. I published numerous articles in the GI field on this topic. If you live here locally, come see us on the guest show, we can take care of all of your issues. So if you're new to this podcast, in the very beginning, I do a deep dive onto a topic, then towards the very end of the video, I do more questions and answers if you've joined me on my live stream, which typically is on all my social media pages. If you haven't already, I need a huge favor. I give you a thumbs up, a like, a share. The social media giants and the iTunes, the library really do help to select a podcast. We can share this information to other people as well. So if you know anybody who may enjoy this information, let me know. So before we begin, we have a couple of housekeeping things to kind of get through. So obviously I'm doing this on my live stream on a Tuesday, which is not what I typically do. These next couple weeks, I'll be going on vacation. So we'll be pre-recording a lot of the podcasts we'll be hearing. So next week in the week after, you'll be hearing some new podcasts that I'm doing, but you will not have a live stream from them because they'll be pre-recorded. So if you're listening to this on the podcast player, it should be okay. But if you're hoping for a live stream for the next couple of weeks, I'll be gone on vacation, but you should be able to watch my videos on my social media channels. And certainly you're able to join the live stream as well. Number two, you may have noticed that we're switching our times, but we did switch our time to Monday at 6.30 p.m. for the live stream. We thought this was more of an easier time, hopefully before dinner, and we're getting a lot of good response to that as well. So today's topics, we're gonna talk about exactly what does it mean when your stool changes? When it changes color form and shape, what does that mean? And also when to worry, we'll also discuss in terms of whether you should consider using Oatmeal as a way to help out with constipation. We'll also discuss as well, other ways that you can do to help differentiate between IBS and IBD and other topics you guys may have on today's podcast. So let's begin, what does it mean when you have a change in your bowel habits? Or whenever you have a change in your bowel color, we'll discuss exactly what is considered a healthy stool, we'll discuss exactly what is considered an unhealthy stool, we'll discuss what are some of the causes of when you do see a change in stool. And at the very end, I'll discuss exactly when you need to see a doctor about some of these changes. So the important thing just to kind of begin is that what is kind of considered normal? And that's the important thing 'cause a lot of people don't realize exactly what is normal. So the first thing is that any shade of brown is normal. That's what I want you to really understand. A lot of people get understandably upset when their color changes, you know, changes from dark brown to light brown to medium brown. And I'll tell you, if you have brown, don't frown because that means that is a normal color. And that's something we don't wanna really worry about that. And so when we think about kind of a healthy stool, the color is the first thing we look at. And if it's any shade of brown, whether it's dark brown, light brown, mocha brown, it doesn't matter as long as it's brown, that's all that matters to me. Number two is we also wanted to consider the consistency of the stool. How does it look? So it's gonna be graphic what I'm gonna describe to you right now, but a sausage shaped stool. Yes, I know we have all sorts of analogy when it comes to food and the gut, but a sausage shaped stool that's long, that's connected, that's not thinned out or has cracks, that is considered the perfect poo, the golden poo that we want. That is the consistency of what a normal bowel movement should be. Frequency, very common question I get for my patients. Hey, Dr. Rissam, how often should I use the restroom? And let me tell you, you'd be surprised what is considered normal. So it can range from as few as three times per week to as much as three times per day, that wide range is considered normal. So if you're going four times a week, guess what? That is normal. And I'll go into more details about what I mean by this, but the frequency of your stool, that's kind of the normal ones we have. Next is the size and the shape. So roughly about eight, four to eight inches is kind of the length. I don't want you to go out there and be measuring your bowel movements. That's kind of weird, don't do that. You can kind of get in guess summation, you know, about this big or so, kind of depending on how big your hands are as well. The last category that we use to determine if you have a healthy stool is the ease of the passage. And what I mean by that is, does it go down the shoot easy? Or do you have to strain, do you have to push, do you have to, ah, or does it just water coming out? But if it's easy, it just glides on through. It's like no effort that is considered a healthy stool. So if you have that, that means things are good. So let's now do a deep dive of what is considered an unhealthy stool. Let's talk about color. So there are certain colors that I see or that you tell me that makes me worried that something else is going on. So one is black. So when you have black stools, that is not typically normal. Now certain medications can cause black stool, so pepto-bismol, iron. But what I worry about when I see black stools is that you're bleeding somewhere in the upper GI tract. That is called melana. And that has a distinct, tarry type of blackness to it in this stool. Another color that may not be normal is red. Red is blood. Blood is not normal. I don't care if you think it may be from hemorrhoids. Any type of blood in your stool is not considered normal. So if you have any blood, don't ignore it. If you have maybe yellow type stools, that's not considered unhealthy. That could be a sign though, that you have too much bile inside your colon that's going into your stools. And then lastly, if you have consistent pale colored stools, that could be a sign of a blockage somewhere in the bile ducts, in the pancreas, in the liver. And that may be a sign of something a little worrisome is going on. So those are considered unhealthy colors when it comes to stool. Let's talk about unhealthy consistencies, the same kind of general topic. What is considered an unhealthy consistency? So you really want your stools to be really well-formed and brown and like a sausage shape, but you can have different spectrums that are not normal. So if you have stools that are like rock hard, like pellets, and it's difficult to come out, it just comes out in little pellets, that is considered an unhealthy stool. On the other side of the spectrum, if it's all water, you just have water coming out, it's just liquid, that is also considered an unhealthy stool. So if you have these spectrums that are there, that consistency is something we don't typically want to have. Next is frequency. We talk about how frequencies you go between three days and three times per day and three times per week. But more importantly for that, I don't want you to focus on the number, I want you to focus on how you feel. So when you use the restroom, do you feel like you're going as good as you can be? Or do you feel good when you have a poop? 'Cause that's more important for me in the number. In fact, I would put a, in terms of all the things I'm talking about, frequency is probably gonna be the thing I don't really care about the most, 'cause it doesn't make that much of a difference for me. However, the only exception is if you notice a change in the frequency of how you're going. So you used to go three times a day, but now you're going only once every two or three days. Or you used to go three times a day, but now you're going eight times a day. If you have a new change for what is considered normal for you, that is not healthy. That's something we need to find out exactly what's going on. So let's talk about shape. You know, I mentioned kind of the 48 inches around that, around that length. So if you have pencil thin stools, or very irregular shaped stools, or you have kind of, it's not coming out all the way, these are certain shapes and sizes that make me worried that something is going on inside the colon and causing a blockage to occur. And so if you have that, there's something that certainly does need further investigation so we don't miss what's going on. And then also, like I mentioned before, blood and mucus. This can be a sign of inflammation that is going on, that needs to be addressed, that needs to be talked about, because that could be something that could lead to something bad in the future for you. So now that we talked about unhealthy stools, what causes unhealthy stools? Why are your stools acting like this? One of them is certainly diet. Dietary changes can make these changes to occur. So if you have foods that are known to be pretty pro-inflammatory, so processed foods, greasy foods, foods that are fast foods, this can certainly destroy your gut microbiome. And by doing that, they can change your stools from healthy to unhealthy. Certain medications can do the same thing as well. So you take blood pressure medications, for example, you take iron, you take pepto-bismol, these are things that are known to change the caliber and the size of your stools. Or if you're taking pain medication as well, it does the exact same thing as well. Next, if you have a certain condition inside the gut, so Crohn's disease, clitis, irritable bowel syndrome, these can also cause your stools to look unhealthy. In fact, the unhealthy stool could be a sign of these conditions as well. Next is certain types of stresses that can occur in your life. So whether it's physical stress or mental stress that can manifest to a lot of my patients with bowel issues to make their bowels maybe not work as properly or as effectively as it should. And then also, what I do have to tell you, cancer. Absolutely, colon cancer or rectal cancer can cause you to present with unhealthy stools. And that could be a sign of something bad that's going on there as well. And so this is why it's very important to use your stools as a check engine light to see exactly what is going on. So there are certain red flags that I try to listen for when I'm seeing a patient about their stool. So there are six red flags that I want you to be aware because if you have these, you need to see a doctor immediately or come to see someone like me so we can find out exactly what is going on. So number one, blood in the stool. I mentioned this so many times, but any type of bleeding, any amount of bleeding and even the smallest frequency that can be a sign of something bad, you need to get that investigated. Number two, black stools. It's called melanoma, M-E-L-E-N-A. These are black tarry stools that could be a sign of an ulcer that's bleeding in the upper GI tract. If you have this and needs to get investigated so we can see exactly what's going on. Then number three, severe abdominal pain. You should not be having severe abdominal pain with your bowel habits. You shouldn't, that's not normal. If you're having that, come see me. I can find out what is going on. Number four is weight loss, especially unintentional weight loss. Now I know in the age of the GLP1 agonist with what GOVI knows them, but yeah, we wanna lose weight, but you don't want to lose weight intentionally, especially if there's a sign of something going on in your colon, 'cause if that's the case, come see us. Number five is a new change in these bowel habits after the age of 45. 'Cause what that means is that there could be a blockage in that colon, that blockage could be a polyp or it could be a cancer. And if that's the case, don't ignore that. And then lastly, if you have a family history of colon cancer or inflammatory bowel disease and you're having these bowel issues, that means that something else is going on when you find out what that something else is and hopefully get that taken care of for you so we can resolve what is going on. So I hope this is helpful for those individuals that are wondering about what's going on with your stool. If you want to learn more, don't forget to subscribe to my channel. If you live here locally, come see us live at Gash Show where you can find out exactly what is going on and hopefully find out what we can do to get things taken care of. All right, there's a question that's here for. Ruben asks, "Hey, Dr. Islam, "what are my thoughts on floor store, "secret mighties balardi as a possible probiotic?" So it's a great question because this gets me into my spiel about probiotics. So there's so much information and false information out there about probiotics and people get confused. So let me tell you exactly what you should know from someone who's been, who's a trained GI doctor for over 10 years who studies this every single day. Here's my recommendation. So number one, not everyone needs to be on a probiotic. It's not the cure-all, it's not the end-all, it's not gonna solve world peace or everything else. So if you don't need to be on a probiotic, don't worry about it and don't get that taken care of for you. Number two is that if you want to try probiotic, try it for a couple of weeks because that way you can just see how you do. And if you don't notice a response in a couple of weeks, that's fine, not a big deal because if you don't get a response within two or three weeks, don't even worry about it. Number three, the most expensive probiotic is not always the best. And so save your money, pick the easiest one that's gonna be good for you. And number four, if you feel like you're getting some benefit, try and see how you do, not a problem at all. And then number five, always, always, always talk to your healthcare provider about what you're adding onto your diet and supplements 'cause that may not be the best thing for you. So these are things that I tried to tell my patient when it comes to probiotics and what you should do. There are gonna be so many things you can see on the internet and social media about the benefits of this. And I'll tell you, and frankly, we just don't have a lot of evidence, we just don't know. So with this specific probiotic floor store, there actually is good evidence that in some individuals who have IBS or irritable bowel syndrome, it can help out. So out of the millions of probiotics that are out there, floor store is one that I actually do recommend 'cause it does have some clinical evidence. And so, if you feel like you benefit from this and you have a condition like IBS or blowing your dissension, absolutely try it, see if it works, always talk to your healthcare provider because this may be the best option for you. And if you guys want me to do more videos on probiotics, let me know 'cause we can hopefully get that taken care of for you as well. So, the question was asked here, Dr. Islam, I feel like I poop constantly. I've had a full workup. What can I do to help improve my digestion and hopefully get things taken care of? So it's a very good question. So in this case, that feeling of pooping constantly, you actually may not be pooping as much as you think you are. So did you know you could be pooping every single day and still be constipated? And this is, if this sounds like you listen up because you actually may have a condition called pelvic floor dysfunction. And what this basically is, our rectum, the very bottom right there, it is a muscle that relaxes once you feel the urge to and you push things out. This is what the sphincters are for, both the internal sphincter and the external sphincter. And in some individuals, that sphincter actually may be too tight. You are literally, anally retentive. So what that means is that you have a bowel movement, your rectum expands and you poop and then up it closes again. Poop closes again, pooping closes again. Whereas you normally should try and do this and push things out, but in pelvic floor dysfunction, because the rectum is so tight, you're actually not getting complete evacuation of your bowel habits. And so with this, your colonoscopy will be normal. Your upper endoscopy will be normal. Your blood testing will be normal. So there's two ways we can diagnose this. One is that we can literally put, do a rectal exam, check the rectum out, see if it's too tight. And then we can see if you have that, that we send you to get therapy to get this fixed, or we can do what's called anal rectal menometry, where we actually check the pressures of the rectum to see how tight it is. And we send you to a physical therapist to get that taken care of you. So just like I do physical therapy to help out with my shoulder, it's the exact same thing with pelvic floor dysfunction. Use physical therapy to help out with the muscles of the rectum to allow them to work easier. So I would suspect that if you feel like you're going to the bathroom every single day, but you don't feel like you're empty, everything out, you actually may have this problem, this condition, which is a very common condition to have, and actually can be a very fixable condition as well. It's a great question. It allows me to do a deep dive on a topic that I really feel like a lot of people don't realize that they have, and there are a lot of effective options we can do to hopefully get that taken care of as well. Another question I got, hey Dr. Ristel, I've noticed that when I fart, it feels like a knife. What is going on? All right, I like this question even more because this is a question I actually get all the time in my office. In fact, this is one of those questions I know people are wanting to know because they ask this question right when the visit is finished and is about to leave, like, oh Dr. Ristel, we got one more question. And these are the questions that I love because this is the real reason why you're coming to see me because you're embarrassed to ask this question. So what is going on? So the reason why whenever you fart, you may feel like you have a knife kind of in your bottom is because you have what's called a fissure, a tear in your rectum. Your bottom does not like a paper cut. I don't like it, your bottom certainly doesn't like it. Your bottom is full of all these blood vessels, these nerves, these areas that are there. And any small little cut, it's gonna feel like shards of glass. And so this is why you're having that pain that's there. Now, there are other reasons why besides this, besides a fissure, sometimes it can be a hemorrhoid, it can be a sign of a cancer, also, honestly, it can be, and also it can be a sign of all sort of colitis or crone. So there is a work that we have to do to kind of see what's going on. We would obviously start off with a rectal exam so we can inspect the area and see what's going on. We may consider imaging. We may want to consider taking a look with a colonoscopy so we can see visually what is going on and then we can get a better idea. But assuming that it is a fissure, which is the most common reason while you have that knife like sensation in the bottom, what can you do? So first thing we do is that we need you to have softer bowel movements. You need to not push. You need to have soft bowel movements. A lot of things have passed through easier. So use things like magnesium, stool softeners, squatty potties, these things work. Number two, using a sits bath actually has evidence. It can help to relax that area, to allow things to not be so tight and cause some pain. Number three, we can actually give you a cream called a nitro glycerin cream. Very similar to what your heart is doing. You give it for your heart. We also give it for your bum. Yes, we do. And the reason we do that is because you're erecting when it has a tear, it's so tight cause it's just spasms up. And that spasm does not allow the blood vessels to go to the area to heal up that tear. And so by giving you a nitro glycerin ointment, it relaxes that sphincture to allow the blood to go in there and allows that to hopefully alleviate and remove the symptoms and help up, help out with the healing process as well. And sometimes we'll get some topical treatments to get things feeling better as well. So if you're having a pain in the bottom, it's most likely a tear. But make sure you see a doctor so we can investigate what's going on. Obviously if you have hemorrhoid issues, come see us. We can investigate what is going on. And I'll forget that taking care for you as well. (water splashing) The other question was asked, "Hey Dr. Islam, "I noticed that one day I had some blood in my stool, "but the following day it went back to normal. "What do you do?" I am so glad you asked this question. This allows me to go in my soapbox about your stool color. So I just mentioned this before, but your stool is the check engine light for what is going on in your body. And there are stool colors that are normal and abnormal. Red stool, 100%, even one time, even a little bit is an abnormal color. I'm gonna stress this. Do not ignore this. Do not assume it's just a hemorrhoid. There is something going on. So I'm gonna tell you story of a patient of mine that had this exact same scenario. It was a 40 something year old individual, very, very young who was having intermittent bleeding off and on for a couple of years. One time it was red, one time it was brown, it wasn't on a consistent basis, not a big deal. But his wife insisted on him to see me because she was worried as all wives should be about their husband's health. So he came to see me. He was reluctant to see me. He's like, "Oh, I don't wanna come see you. "Come on, it's just not a big deal." I did erectile exam. I felt hemorrhoids. I knew he had hemorrhoids, but I also told him, "Listen, bleeding is ever normal, "even one or two times is all you need sometimes." Let's just take a look and see what's going on. I know you don't want this, but let's just make sure everything's doing okay. We did a colonoscopy and guess what we found. We actually found a massive pre-cancerous polyp. So it wasn't cancer yet, but it was actually about to lead to cancer. Because of small intermittent bleeding, we removed that polyp and that polyp, probably in the next couple of months, would have progressed the cancer. This guy and his wife saved his life. So more of the story is, if you have any blood, get your colonoscopy. I don't care if you think it's nothing. It is much better to have a conversation telling you. We found hemorrhoids. We found a fish or we found a polyp. We took it out, you're good. As opposed to having a conversation, which I say, "I am so sorry you have colon cancer." That is literally the worst conversation I ever have with a patient. So don't become a statistic. If you're having blood, even one time, come see me so you can find out what's going on and don't forget root cause of why you're having the issues and get you feeling better as well. All right guys, using a great question we had. I think we had a good podcast today. So I want to thank you guys for watching. If you haven't already, don't forget to smash that like button, like, share and subscribe. If you like what you're watching, if you like what you're hearing, give us a fine start review. If you want more information, come see us on the guest show. And what I need from you guys, I need feedback. What do you like? What do you not like? What topics do you want? What do you want to hear about? Give me some information. You can feedback or love to hear. This is for you. I can talk to anybody about this. We want to try and prove your health in your life. Let's see. I look forward to seeing you guys. Don't forget the next couple of weeks. I'll be not doing a live video, but I'll be still doing my podcast and my videos on my channel. So stay tuned for that if you want information. I'll see you guys towards the end of July, after my vacation. Hope you guys have a great day. Hope you guys have a healthy rest of the couple of weeks. And stay healthy and you guys take care. Thank you. (upbeat music)
