Poo-Torial

This colour of poo is normal and healthy. The colour is normally described as chestnut brown but could be a little lighter or darker depending on what you eat. It is important to know what is normal for you. Don’t forget to check out the consistency of your poo and toilet frequency too!
Poo that is brown means the gut is healthy if no other symptoms occur. The brown colour is due to a substance called bilirubin, which is produced in the liver from breaking down old red blood cells and bile. Bile is also produced by the liver and helps digest fats in food.
There are other substances in poo:

• Microbes (bacteria, fungi and viruses). Learn more about the microbes living in your gut here, and how important they are for your overall health.
• Dead cells shed from the lining of the digestive system. This normally happens as the cells of the gut get replaced rapidly.
• Fibre, the indigestible parts of plants. Learn more about fibre and how fibre can benefit your gut health here.
• Other nutrients that haven’t been fully digested (protein and fat) but which your body does not need.
• Mucus.

Sometimes poo can be black in colour if you are taking iron tablets, or a medicine based on bismuth. It can also be black if you have eaten a lot of liquorice. If the colour is a side effect of the medicine or iron tablets, it should not cause a problem. But if you are concerned you can speak to your doctor or a pharmacist. Do not stop taking your medicines without seeking advice from your doctor. This type of poo is not generally sticky or tarry.

Black poo can also mean bleeding higher up in the digestive system, for example from the stomach. You should see your doctor if your poo turns black for an unknown reason.

If your poo is black, looks like tar and has a bad smell, it might mean that your digestive system is bleeding significantly. The bleeding is generally further up in the digestive system, either the oesophagus, stomach or first part of the small bowel (the duodenum). The poo is black and tarry because the blood has been partly digested. This situation is a medical emergency, and you should contact the NHS urgently.

Bleeding resulting in black poo can happen with many digestive conditions such as:

• Liver disease and ascites associated with liver disease.
• Stomach cancer.
• Oesophageal cancer.
• Stomach or small bowel ulcers, which are usually caused by a bacteria called Helicobacter pylori.

Bleeding may not be because of a cancer for most people, but seeing your doctor can help you to find out the cause and get it treated.

Poo can sometimes become grey if someone is taking medicine to treat diarrhoea, such as bismuth-based medicines. Very pale or grey poo might also mean that your pancreas or liver is not working properly. The tubes leading from these organs may be blocked.

If your poo turns grey and it is not caused by medicine, food or iron tablets you should contact your doctor. Do not stop taking your medicines if you suspect a medicine is the cause, without advice from your doctor.

This colour of poo might be caused by the following:

• A blockage of the tubes from the pancreas or gallbladder caused by gallstones.
• Inflammation caused by acute pancreatitis.
• Chronic pancreatitis.
• Pancreatic cancer.
• Jaundice.

The colour change is caused by the pigments that are in bile. Bile is a substance that helps digest fat. With pale coloured or grey poo, the pigments are not being released into the digestive tract as they normally would be. This colour of poo often happens with a symptom called jaundice. Jaundice occurs when the bile remains in the blood instead of going into the digestive system. Jaundice causes a yellowing of the whites of the eye and skin (which may be less obvious in people who have darker skin). If jaundice occurs, you should contact your doctor as soon as you can.

Green poo can be caused by eating a lot of green vegetables, or green food colouring in food and drink. Green poo is entirely normal in young babies. It can also be caused by antibiotics, or a gut infection like food poisoning/gastroenteritis. Symptoms of an infection will usually change the consistency of poo and frequency of going to the toilet too.

Do not suddenly stop taking your medicines if you feel medicine is the cause of green poo, discuss this with your doctor first.

Take note if your poo turns green and you have symptoms such as diarrhoea, cramping pain in the central or lower abdomen and feel unwell with a temperature. Food poisoning or a gut infection like food poisoning/gastroenteritis might be the cause.

The green colour of poo, if someone has a gut infection, is usually caused by the bacteria salmonella, a parasite called giardia, or a virus called norovirus. Most gut infections do improve in five to ten days with self-care. Read more about food poisoning and gut infections here.

Contact your doctor for the following:

• If symptoms of food poisoning do not get better in four weeks.
• The poo changes to a red colour.
• If you develop severe and constant abdominal pains with a high fever.

Green poo can also be caused by a condition called bile acid malabsorption, where bile stays in the stools without being reabsorbed, and hence discolours the poo. This can occur if you have liver or gall bladder disease, or if you have had surgery or disorders of the small intestine.

Red poo can be caused by beetroot and red food dye in food and drinks. But red poo could also indicate bleeding in the bowel. Bleeding in the bowel can be caused by:

• Ulcerative colitis.
• Crohn’s disease.
• Diverticular disease.
• Bowel cancer.
• Food poisoning or gastroenteritis can cause blood in poo if the infection is severe.

If the blood is coating the outside of the poo this might be a result of piles (haemorrhoids) or anal fissures. Contact your doctor if you think you have bleeding in your bowel.

Red poo where the cause is not food related should always be discussed with your doctor. Bright red streaks on the outside of poo might be caused by an anal fissure or haemorrhoids. Deeper red (maroon) poo might be a sign of bleeding further up inside the large bowel. You should contact your doctor if you have either of these colours of poo.

Orange poo can happen if someone has eaten a very large amount of food containing a substance called beta-carotene. Beta-carotene is found in foods such as carrots (these are not likely to cause a problem in normal portion sizes). Orange poo can also be caused by a condition called bile acid diarrhoea, where bile stays in the stools without being reabsorbed, and hence discolours the poo. This can occur if you have liver or gall bladder disease, or if you have had bowel surgery or disorders of the small intestine.

Beta-carotene is a pigment found in plants and the body converts beta-carotene to vitamin A and it is found in orange, green and yellow fruits and vegetables. These are not likely to cause a colour change in normal consumed amounts. It might also be found in vitamin and mineral supplements containing vitamin A. It is not advisable to take high levels of vitamin A from supplements, as this can be harmful. Most people who have a healthy balanced diet do not need to take vitamin A supplements.

Bile acid diarrhoea can also occur in the following conditions:

• Crohn’s disease, when there is inflammation present at the end of the small bowel (known as terminal ileal Crohn’s disease).
• Up to one in four people who have Irritable Bowel Syndrome with diarrhoea may actually have Bile Acid Diarrhoea, so this should be considered if poo is orange and IBS diarrhoea symptoms are severe.
• Bile acid diarrhoea can happen after surgery to remove the gallbladder.

Occasionally it can occur with other malabsorption conditions, like:

• Coeliac disease.
• Chronic pancreatitis.
• Pelvic radiation disease.
• Bowel cancer.

Yellow poo can be caused by a condition called bile acid diarrhoea, where bile stays in the stools without being reabsorbed, and hence discolours the poo. Yellow stools can be caused by too much fat inside the poo, the medical name for it is steatorrhoea. Occasionally this is caused by a medicine prescribed for weight loss (orlistat). Do not stop taking your medicines without discussing it with your doctor.

Yellow, fatty poo often smells bad too and can be described as ‘greasy’. People with Irritable Bowel Syndrome (IBS) can sometimes have symptoms when they eat fat in their diet. However, steatorrhoea might indicate the fat that is eaten in the diet is not being absorbed well. Other causes can be coeliac disease or pancreatic exocrine insufficiency (PEI).

Yellow poo could also be caused by an infection in the small bowel. See your doctor if you suspect that you are not absorbing fats.

Poo that is yellow, floating and greasy can often be difficult to flush and it might take more than one flush of the toilet to get rid of the poo. Sometimes if this symptom is severe, there can be visible oil floating on the surface of the toilet water.

Not absorbing fats is called a malabsorption problem. Malabsorption can happen with the following:

• Coeliac disease. Your doctor can check for coeliac disease with a blood test. Ensure you are eating sources of gluten as this is needed to ensure the test will identify coeliac disease.
• Pancreatic exocrine insufficiency (PEI). PEI is common in people with chronic pancreatitis.
• PEI can also happen occasionally with acute pancreatitis, surgery to the pancreas and pancreatic cancer.
• People with type 1 diabetes who are having digestive symptoms might also occasionally have PEI, which may also potentially be responsible for variable glucose control.
• Type 3c diabetes.

This is a very rare colour of poo and is not a good sign. The silver colouration is produced by combining black tarry stools and grey stools containing fat, due to malabsorption. This colour of stool should be discussed with your doctor urgently as it may be a symptom of cancer. This kind of cancer develops in the tubes leading from the gallbladder and pancreas and is called ‘Ampullar of Vater cancer’.

The Ampulla of Vater is a small opening where the pancreatic duct and the bile duct join. Rarely, a cancer can develop inside the opening and blocks the opening. This will stop any secretions from the pancreas and the gallbladder from entering the small bowel. The combination of the malabsorption of fats and the lack of release of bile, plus if the cancer is causing bleeding, can make the poo look a silvery colour.

This kind of poo may be combined with a symptom called jaundice. Symptoms of jaundice happen when the bile remains in the blood instead of going into the digestive system. Jaundice causes a yellowing of the whites of the eye and skin. Skin yellowing may be less obvious in people who have darker skin.

The cells lining the digestive system normally produce mucus to help the poo travel easily through the gut. It is not always visible, but it is there. Sometimes people with Irritable Bowel Syndrome (IBS) can see visible mucus when they go to the toilet, this can also happen sometimes if someone is constipated. Mucus can also sometimes be seen with other diagnosed bowel conditions.

Mucus is a slimy, sticky, jelly like clear fluid normally produced by the cells lining the digestive tract all the time. It is not harmful to occasionally notice mucus in poo or when you wipe your bottom after opening your bowel if you are constipated (check poo consistency section), or have been diagnosed with IBS. You should contact your doctor if the mucus is a new symptom or if the mucus contains blood. You should also contact your doctor if new symptoms develop that might mean a different diagnosis, such as abdominal pain, bloody stools, a change in bowel habit and/or vomiting.