Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

We all do it. For some, it’s a necessary inconvenience; for others, it’s a pleasant and satisfying part of the digestive process. It has fascinated toddlers since time immemorial, and there’s a reason for that. Going ‘number two’ might not be the prettiest topic for a dinner party, but there’s a lot to learn from this mundane yet mysterious process. In the end, it’s simply a part of our functioning body.
The stool is mostly just undigested food, proteins, bacteria, salts, and other substances that are produced and released by the intestines. Although everyone is unique in the size, shape, and smell of their stool, there are a few things that indicate a healthy (or unhealthy) stool.

Healthy stool
A healthy stool can be as varied and as unique as the individual who makes it, but there are a few general rules to follow when assessing stool artistry for optimum health.
• Colour
The stool emoji has one thing right: the brown colouring. The combination of stomach bile and bilirubin, which is a pigment compound formed from the breakdown of red blood cells in the body, gets the credit for this oh-so-lovely shade of brown.
• Shape
A somewhat log-like shape is how most stools should come out, due to their formation within the intestines. However, there are a variety of shapes that stools can have. When they differentiate from the log shape, that’s when they are trying to tell you something’s up.
• Size
Stools shouldn’t come out in small pellets, but instead should be a couple of inches in length, comfortable, and easy to pass.
• Consistency
Anywhere between a firm and soft consistency is pretty much normal. If it sways too much one way or another, it could suggest some digestion or fibre issues.
• Length of time
A commonly heard joke is that when someone takes too long in the bathroom, it must mean they’re stooling. A healthy stool, however, should be easy to pass, and take only a minute or so to be pushed out. That said, some people do spend a bit more time on the toilet; so, as a general rule, stooling should take no more than 10 to 15 minutes.
• Frequency
Fun fact: Did you know most people stool around the same time every day?
On average, a person with healthy digestion would stool anywhere between every other day and three times a day. Any less could suggest possible constipation.
The Bristol Stool Chart is an overarching indicator of how and why different types of stools look or feel a certain way. It’s broken up into seven categories based on a 2,000-person study published back in 1992, and it makes stool knowledge basic and easy to understand.

Type 1: Marbles
Appearance: Hard and separate little lumps that look like nuts and are hard to pass.
Indicates: These little pellets typically mean you’re constipated. It shouldn’t happen frequently.
Type 2: Caterpillar
Appearance: Log-shaped but lumpy.
Indicates: Here we have another sign of constipation that, again, shouldn’t happen frequently.
Type 3: Hot dog
Appearance: Log-shaped with some cracks on the surface.
Indicates: This is the gold standard of stool, especially if it’s somewhat soft and easy to pass.
Type 4: Snake
Appearance: Smooth and snake-like.
Indicates: Doctors also consider this a normal stool that should happen every 1 to 3 days.
Type 5: Amoebas
Appearance: Small, like the first ones, but soft and easy to pass; the blobs also have clear cut edges.
Indicates: This type of stool means you’re lacking fibre and should find ways to add some to your diet through cereal or vegetables.
Type 6: Soft serve
Appearance: Fluffy and mushy with ragged edges.
Indicates: This too-soft consistency could be a sign of mild diarrhoea. Try drinking more water and electrolyte-infused beverages to help improve this.
Type 7: Jackson Pollock
Appearance: Completely watery with no solid pieces.
Indicates: In other words, you’ve got the runs, or diarrhoea. This means your stool moved through your bowels very quickly, and didn’t form into a healthy stool.

As with size and consistency, stool’s colour can be a helpful signal about what’s going on within your body. As we previously mentioned, varying shades of brown are what’s considered the norm. Even a hint of green is considered healthy.
• Black
Having liquorice, iron supplements, or bismuth medications (such as Pepto-Bismol) could be the explanation behind the black stool. If the diet cannot be explained, black stool could be a sign of bleeding in the upper gastrointestinal tract.
It may seem like red would be a more likely colour for this sort of concern, but since it’s taken a while to travel down, it’s older and therefore darker.
• Green
While hints of green are quite normal, if stool has gone from brown to full green, it may mean one of two things. Either there were lots of green foods, like spinach, added to the diet, or the stools passed through the intestinal tract too fast. When it doesn’t pick up as much of the brown-tinting bilirubin, it has more bile salts that turn it this colour.
• Pale, white, or clay
When the stool is a chalky light shade, it might mean it’s lacking bile. Bile is a digestive fluid that comes from the liver and gallbladder, so producing white stool probably means the bile duct is blocked. The pale stool could also be a side effect of certain medications, like anti-diarrhoea medicine. Either way, if it continues, consult a doctor.
• Red
Red stool can mean bleeding, either due to haemorrhoids or to bleeding in the lower intestinal tract. If the stool is a little red, however, there may be no need to immediately fret. There are other, less serious reasons for this change in colour. Foods like beets, cranberries, red gelatine, or tomato juice can turn stool red as well.
• Yellow
Greasy, stinky, yellow stool is typically a sign of too much fat. This could also be a direct relation to a malabsorption disorder like celiac disease, where the body isn’t absorbing enough nutrients. If the stool looks bright yellow, it could signify a condition called giardiasis, which is caused by an intestinal parasite.
A green stool here or hard stool there happens to the best of us. It’s when this type of irregularity carries on for more than a day or two that action should be taken and a talk should be had with a doctor. The same goes for changes in colour or consistency, or constipation.
Chronic constipation can obstruct the bowels, while chronic diarrhoea can make it difficult for a person to absorb necessary nutrients from food. Both chronic constipation and chronic diarrhoea could even be a sign of more serious conditions.
The first sign of either of these should not be immediate cause for concern, but keep an eye on it and see if it lasts for more than a few days. That said, pay attention to any sign of blood. Our stool can provide a wealth of knowledge about our health and ourselves.