What Your Poop Says About IBS: Stool Types, Colors & Overflow Diarrhea Explained

Jessie (00:00): Hi there and welcome back to the IBS Nutrition Podcast. I’m your host, Jesse Wong, FMAP certified dietician, and the founder of IBS Freedom Program and team IBS dietician. Now, before we dive in, I want to share something a little personal. A couple years ago, my daughter wrote me a Mother’s Day poem when she was in second grade and it went like this. My mom is a dietician. She knows a lot about poop. When she looks at it, she knows what type it is. The poop she sees is not goop. I know. Imagine how I felt when I received that poem on Mother’s Day. I loved it so much and my kids knows that she’s not wrong. It’s very true. I look at a lot of poop and my kids have definitely seen me looking at our client’s poop and assessing what’s going on with their guts.

(01:00)And here is the thing, poop tells us so much about what’s happening inside your gut, especially if you have IBS. If your stool is all over the place, sometimes hard, sometimes loose, sometimes alarmingly weird, you are not alone. Most people don’t know how to interpret their bowel movements, and that creates confusion, anxiety, and mist pattern that could actually help you feel better. So in today’s episode, we are going to break it all down. What is your poop made of? What’s normal and what’s not when it comes to stool types and color and what clue your poop might be giving you about your IBS? Let’s get into it. So number one, poop isn’t gross. It’s information. Most people think of poop as something to flush and forget, but from a gut health perspective, stool is one of the most powerful and non-invasive tools. We have to understand what’s going on inside your body.

(02:17)Poop is made up of water, bacteria, fiber, and cells that your body shed and sometimes undigested food. When things shift in your digestive system, whether it’s from diet, motility issue or inflammation, your poop reflects that. Let’s take the Bristol stew chart as an example. It’s a visual scale from type one to type seven that helps categorize your stoop. Type one and type two is constipated type three and four is ideal. Ideal type five, two type seven, loose or diarrhea. So what we want is somewhat around type three or type four. Anything outside that range is worth paying attention to. Alright, so the key concept here, I want to help you reframe this, is poop isn’t gross, it’s your body communicating with you. It’s a daily feedback loop, and this is where it really starts to make a difference when we begin to treat our stool.

(03:25)Your poop as a tool, not something to be ashamed of. Once you see your poop as a clue, not a nuance, you can actually begin to decode what’s happening in your gut. Lemme give you a real life example. So this is one of our clients, kin. Kinsey came to us with what she thought was chronic diarrhea. She had urgency all the time, loose stool and anxiety around leaving her house. She had tried probiotics, elimination diets and basically cut out half of her diets and nothing helped. When we started tracking her bowel movements, we discovered that she wasn’t dealing with diarrhea at all. She was actually severely constipated and experiencing overflow diarrhea. Once we addressed the underlying constipation with motility supports, dietary changes and tracking, she went from living in fear to having daily normal pain-free bowel movements. Again, it’s really important before you cut out any food to see what is actually going on.

(04:34)Kinsey came to us already cut out half of the food she was eating because she was so afraid of eating, but when in reality it has got nothing to do with food, she did not have any food trigger. Now, I have created a website that is free and it is a visual reference where you can actually see what different types of poop look like in real life. Yes, real poop pictures, not just cartoon drawings where it is like a bit ambiguous sometimes. So if you’re not sure what your stool looks like, whether it is normal or something to pay attention to, check out our website poop p.org. So it is P-O-O-P-E-D-I a.org, RG. It makes it super simple and easy to understand and compare your stool to other people’s stool that we have categorized into different stool types. I know one of the comments I hear from our clients and also talking to other providers as well is that the Bristol stool charts is great, but when you compare the real stool picture to the Bristol stew charts, it’s never really the same.

(05:55)I mean, sometimes it is, but not always. And it’s always helpful to see within a stool type, what does it look like? What’s the range of stool that looks like? So poop pdia.org is your resource to check out what poop looks like and whether you need to, you need to talk to your providers about your stool. All right, so that was number one. Poop isn’t gross, it’s information for you. So point number two today that I want to talk about is stool type and stool color. Both of them matter. Let’s talk about what’s normal and what’s not. So there are seven screw types. For those of you who have pulled up pedia.org already, you can scroll through the front page and see the cartoon image of the different types. So type one is heart pellets. Usually that indicates constipation. Type number two, it’s lumpy locks.

(06:52)You’re still constipated. So lumpy locks are like heart pellets pushed together. And of course the heart pellets, sometimes you’ll hear people say it’s like rapid pellets, rapid droplets. So that’s type one. And type two is when the droplets are being pushed together, you’re still constipated. And then type three is like sausage lock with some cracks on it. And type four, it’s like a snake lock that has no cracks on it, so it’s soft is smooth, it’s easy to come out. So both type three and type four are ideally quite easy to come out. Type five are more like soft blobs that are broken apart. They are coming out and well, they’re broken apart. Sometimes people call it ribbon like because they are like little pieces of soft blob. And then type six is more mush and loose stool. And type seven is complete watery diarrhea.

(07:55)There you go. Seven types of stools from the Bristol stool charts. And if you want to see pictures, click on each type of the stool on pedia.org. It will bring you to a complete article that talks about different types of stool. And we have blurred images of stool pictures in there. If you want to unblur it, just click on it if you’re on your phone or hover your mouse over it if you are on your computer. So that’s different types of stool. Now let’s also talk about color, because color is a big indicator of what’s going on. It can tell us about transit time. It can tell us about your absorption. And then of course, again, red flags that we want to be aware of. So the first color is what is normal, and that is brown. Brown is always what is normal. Your poop should be brown most of the time.

(08:48)If it changes color once in a while and it goes back to brown, then don’t worry about it. Okay? Green sometimes can be an indication of fast transit, or maybe you’ve eaten food that might have a lot of green color to it, like leafy greens. Sometimes blue color might be cause of foods that have more anthocyanine in them or maybe blueberries. So slight changes in color, that’s okay. Now, if it’s yellow or if it’s greasy, this could be a sign of fat malabsorption. Document it, show it to your doctor and ask to get tested because they can test your stool for fat malabsorption. And then black is where you really want to be careful because black is not normal and sometimes it can be a possible indication of bleeding in your GI tract. Now if it’s black, that means the bleeding might have happened in the upper GI area.

(09:49)So your doctor might order scopes to see what is going on. So if you see black always documented, always let your healthcare team know. Alright, red color. So sometimes if you see red color, it could be an indication of hemorrhoids. It could also be, again, indication of bleeding. If it’s red, that means it’s not being in your GI tract for a long time. It could mean the bleeding occurred somewhere closer to the rectum. Regardless whether it is black or red, you always want to document blood in the stool and you always want to bring it up to your healthcare provider. Both of these could potentially be red flags and life-threatening get evaluated. Now let me share a story that brings this to life because it’s one thing to talk about stool color. In theory, it is another to see it and see how it plays out in real life.

(10:50)And the next case that I’m about to talk about just shows you how much your stool can tell us, especially if you are taking medications. So we had a client recently, his name is Joe, and he was experiencing what he thought was chronic diarrhea. He had to use the bathroom many times a day, often urgent. And it got so bad he started carrying extra clo and pets with him just in case. Now, when we started working together, we suspected overflow diarrhea, which happens when heart stool builds up in a colon and blocks the passage. Liquid stool would leak around it creating loose urgent bowel movements. And oftentimes it happens multiple times a day. Sometimes it is misdiagnosed as regular diarrhea. Joe’s doctor, his GI doctor, actually prescribed a bio acid se question for him to try. So bio acid se question is a medications that helps you better abor bio acids so that it doesn’t cause diarrhea.

(12:05)However, too much bio acid can cause diarrhea as well. And we call it bio acid malabsorption or bio acid diarrhea. That’s when your poop really burns. Okay? So his doctor put him on this medication and hoped that it would help him manage the diarrhea. However, Joe didn’t have bio acid diarrhea to begin with, and when he started the medication, it actually made things worse. His stool changed from loose brown stool to loose yellow stool and very greasy. So this is having fatty diarrhea, what we medically call stator. It is an indication of fat malabsorption, and more likely than not, it was triggered by the medication he was taking. So we recommended Joe to pause the medication and we asked him, Hey, we want to review your past test results. So this is something we do for all of our clients, but then he didn’t upload it in our first appointment, so we reviewed it afterwards.

(13:10)So we wanted to review imaging of his abdominal area. He had x-ray done, had CT scan done as well, and we didn’t really find much. But that’s also around the time he went to a new GI doctor who ordered new imaging. And it turns out he had a significant stool burden throughout his colon. And that confirmed to us that Joe didn’t have classic diarrhea. He had severe constipation with overflow diarrhea, which was our suspicions throughout the time. So once we figured that out, then we really started working on the root cause of all of this, which is constipation. And his symptoms drastically improved, his diarrhea stopped or improved, and he was able to go back to daily life without so much fear like he did before. And more importantly, we did identify a food trigger that we suspected was slowing down his gut motility, causing him to have the significant backup.

(14:22)And when he eats the food trigger, he’s got just cramps and spasms and he doesn’t have full evacuations. And these are the times where stool becomes backed up. Now for those of you who may be wondering what is overflow diarrhea and what it actually looks like, if you want to learn more, I walked through the visual diagrams in our free IBS relief masterclass. You can find it at dietician.com/masterclass. You see pictures and we explain it to you. It’s very well with the pictures to tell you what is overflow diarrhea, what the symptoms are, and also kind of visual of what it looks like in your rectum, in your colon, okay? And also, you don’t need to memorize different stool colors or charts, just go to pedia.org. It breaks it all down for you with visuals and of course, real life photos so you can see what’s typical and what’s not and what needs more attention.

(15:29)I like to think that our website, poop pdia.org is like a visual diary, no visual dictionary for poop. And it is so helpful. So make sure to check it out. Alright, point number three that I want to get to today is overflow. Diarrhea is one of the most misunderstood IBS patterns. Overflow diarrhea is a big one, especially for those of us who actually have IBS constipation. But the symptoms shows up as diarrhea and oftentimes they get misdiagnosed as diarrhea. So overflow diarrhea happens when your colon is blocked with heart stool. You still get urges, especially anytime you eat food or anything that stimulates your bowels to want to produce a bowel movement. At those times when the bowel movement, the heart stool can’t come out, what the contraction and the urgency would cause is the liquid stool to leak around the blockage so that you get a lot of urgency in loose stool that looks like diarrhea, but it may actually be severe constipation underneath.

(16:44)And this happens a lot more than we think. And I want to wrap up this point and maybe share one more case study with you because we see it a lot in our clinic. And if you are experiencing diarrhea, you need to make sure that your diarrhea is not constipation so that you are treating it because a lot of people come to us getting misdiagnosed as IBS diarrhea and all of their treatment is for diarrhea. And that sometimes will make your constipation worse. And this is exactly what happens to one of our past clients, and her name is Kathy. (

17:20)Kathy had daily diarrhea for years. That long sign that I just had is because people with overflow diarrhea or people with diarrhea in general, they suffer so much, right? Everywhere you go, you’re afraid of accidents. What happened, many of our clients told us that they are traumatized when they travel because accidents have happened in the past or have close incidents of having accidents in the past. And it is a real struggle and devastation for IBS patients who are just trying to live a normal life. Let’s say we are not even aiming for ing life rights. Now, when you have nonstop diarrhea, you’re really just hoping to make through the day without any accidents. And that is exactly how Kathy’s life was. She’s tried everything. She’s tried Imodium, she’s tried a ton of supplements, probiotics, fiber supplement, cleanses, detoxes, you name it, she’s tried it. She’s done all of the diets in the world and she’s seen so many healthcare providers, PCPs, she’s seen her primary care physician, she’s seen multiple gastroenterologists.

(18:28)She’s even been to a naturopath and she’s seen other dieticians in the past. But no one realized she wasn’t actually dealing with diarrhea. She wasted many years along with many, many trialing different diets, supplements, and strategies that didn’t work. So when she joined our program, she actually sent me a message before we even met for our first one-on-one appointment. She said, Jesse, I’m reviewing the course. And oh my God, I realized I have overflow diarrhea, which is why, and that explains why none of the treatment approach we’ve done in the past has worked. We were treating the wrong thing. So that was a huge light bulb moment for her. And of course, one-on-one appointment. We really go through her medical history, look at all the labs and tests that she’s stemmed before and really confirmed with her suspicion after reviewing our course materials. So we have a course, it’s called an IBS Freedom course.

(19:33)All of our clients gets it, and you can get it as an a la carte item as well. But it was such a light bulb moment for her and she was so happy we recognized it. And also by looking at her stool and her symptoms, we were able to see the trend as well. Because what she was excreting daily is probably not all the stool that she had in there. You can tell it’s quite, well, I wouldn’t say it’s quite easy to tell. It’s quite easy for me to tell because I’m very experienced in looking into it. Brooke and I are both really good at spotting overflow diarrhea because we see it so often when it’s not a complete evacuation, it is quite obvious. But anyways, so what we did really work while working together is addressing her constipation and what we found by systematic elimination and reintroduction process.

(20:26)We identified a couple food triggers that when she eats them, it slows down her gut significantly. So once we remove those food, her diarrhea stopped and she now has daily complete evacuations, and she no longer builds her life around finding the nearest bathroom. And for those of you who can relate to this or maybe struggling rights now, I want to let you know that there is hope, okay? Don’t give up on it. Diarrhea. Wow, IBS in general is extremely debilitating, but it doesn’t need to be that way. But for you to find relief, and I’m talking about long-term relief, not bandage solution, you really need to understand what is going on in your body, what are triggering your symptoms. So today I shared three cases of overflow diarrhea. So their diarrhea is triggered by constipation, and then we need to dig deeper to see what is causing the constipation so you can actually identify your real trigger and not just guessing here and there.

(21:35)Now, if you want to learn more about why IBS is so confusing, I just recorded in episode. So that is episode 20 that talks about all of these things, why it is so confusing and what you can do to actually get to a better place faster to pinpoint your own trigger faster. But of course, today is all about poop and why looking at it is so important, right? So we’ve talked a lot about poop today from poop types, colors, and also client case studies who thought they had diarrhea when they were really dealing with constipation underneath. Now let’s recap real quick why you need to be looking at your poop before you flush them and potentially documenting them. So poop, give us powerful clues about what is happening inside your gut and what type and the color of your stool can help identify what type of IBS and maybe digestive issues you might be struggling with overflow.

(22:41)Diarrhea is not diarrhea. It is a signal that your gut is backed up. So when you know how to reach your poop, you will be able to stop being afraid of having bowel movements, but instead use it as a tool. All right, if this episode resonates with you, go check out poopedia.org. It’s free evidence-based site that I created to help you better understand your poop and feel less overwhelmed by your symptoms. You’ll find stool examples, tracking guides, and answers to the most common poop questions we hear in our IBS clinic. And I want to also say a quick short message of gratitude. So poop PIA is only here because we had a lot of clients who are willing, who signed a consent for us to use their stool pictures so that we have the library of poop photos for you to see what different types of stool looks like and what are different varieties even within the different types of stool.

(23:56)I want to say a heartfelt thank you to those of you who signed the consent and said, we could use your pictures. You know who you are. Some of you listened to the podcast and sent me messages about it. So I want to say thank you. And I know it’s helpful for a lot of people because we get a lot of emails about pedia and just some in general thanking us for putting it up. There is not a guide out there about poop. And I was very shocked when I came into this profession, actually, when I started becoming a GI dietician. One of the things I really wanted to learn more about was different types of stool and I couldn’t find a guide. And I remember telling my dietetics director at Indiana University, Vicki Getty about this. I said, I’m working with patients with IBS and I’m looking at patients do pictures to learn more about their guts, but there isn’t anything out there for me to check against what I’m looking at.

(24:57)And I’m really frustrated about this. And then I told her I really want to put together a directory so that people can look it up and they won’t be as confused as I was when I started out and after I did it. So we’ve put up pedia for a few years now, and after I did it, I met her at a conference and she just told me she was so proud of me and I want to tell those of you that shared your pictures here, if it wasn’t you, this project would not have seceded. So I just want to say thank you and for those of you who are looking at pedia, I hope it is helpful for you. Alright. Oh, getting a little bit emotional here, but it is a project that I’ve been wanting to do for quite a few years and I’m really thankful for everybody who contributed and for our graphic designer and my web developer for putting it together. So, alright, that’s it for today. So if you want to dive deeper and learn more about fixing the root cause of your IBSI do recommend watching a free 45 minutes masterclass. You can find it on ibs dietician.com/masterclass. That’s it for today. Alright, I hope this episode helps you feel more curious and confident and maybe even a little less grossed out about your poop. Thank you for listening and I will catch you in the next episode.