Worried about your health? Try waste watching

By Jamie Sotonoff

Get grossed out, laugh or act like you're too refined to discuss this. Go ahead.

The truth is, poop is serious stuff.

If you're willing to peek into the toilet bowl once in a while, local doctors say you can learn loads about your health and detect problems ranging from poor diet to colon cancer.

"It's one of a few things you can do without a doctor's help. You can't do blood work on yourself ... but you can look in the toilet," said Dr. Anish Sheth, a gastroenterologist and co-author of the book, "What's Your Poo Telling You?" and the soon-to-be-released sequel, "Poo Log" ($9.95 each, Chronicle Books).

Even though it's a natural, often-daily act by every living creature, many people are too embarrassed to discuss the stinky subject with anyone, including their doctors.

Local gastroenterologists stress the importance of confiding in your doctor if there are changes in your bowel habits. Every doctor interviewed for this story promised that nothing would shock or disgust them.

"They've got to remember, it's commonplace for us to talk about this stuff," said Dr. Don Hoscheit, a St. Charles gastroenterologist who practices at Central DuPage Hospital. "Sometimes it can be just a simple issue, and sometimes it's an indication that something's going wrong in the colon. The worst thing a person can do is sit around and wait and not do anything about it."

While the subject is still largely taboo, a few high-profile media events have helped break the ice -- Katie Couric's on-air colonoscopy, and an Oprah show featuring Dr. Mehmet Oz answering bowel questions for an entire hour.

"The stigma is breaking down somewhat," said book co-author Josh Richman. "There's a change in society, with people taking charge of their own health and health care. Now, you can talk about poo without just making poo jokes."

Still, most people don't know what's normal or healthy and they're hungry for information.

Sheth's Web site, www.drstool.com, has been swamped by visitors who want to anonymously ask the humorous doctor questions about their excrement. Some questions are serious, such as whether there's a connection between a vegetarian diet and frequent diarrhea, and then there are silly ones, like "What's the deal with the never-ending wipe?"

"There is, for a lack of a better term, an explosion of poo in the mainstream now. People want to talk about it," Sheth said.

What is normal?

There's a scene in the 1987 movie "The Last Emperor" where the child defecates into a bowl, the elders examine it and deem it perfect, so he is crowned emperor.

However, the idea of "perfect poo" is fiction, local doctors say.

"There is no normal bowel habit," Hoscheit said. "It's whatever's right for the individual. It's like height. Is there a healthy height? Is there a normal person? But knowing what's normal for you is an important thing."
Bowel frequency, consistency and color will vary greatly depending on age, diet, medications and lifestyle, doctors say.

Some people go twice a day, others twice a week. Sometimes bowel movements turn unusual colors, like red or green. Some are thick and some are thin. Some people get constipated when they travel, or get diarrhea when they're stressed out.

It's all normal, doctors say.

"It's not uncommon for people to fluctuate between having constipation, diarrhea and normal bowel habits," said Dr. Stephen Chang, a Bartlett gastroenterologist who works out of Central DuPage Hospital. "It's the major changes in your bowel habits that suggest there's something changing with your overall health."
So what isn't normal?

The No. 1 indicator of a problem is the presence of blood.

"A little drip here and there ... or a little blood on the toilet paper, that's not the same as large amounts of blood in the stool or blood clots," said Dr. Michael Brown, a Rush University Medical Center gastroenterologist and a member of the American Society for Gastrointenstinal Endoscopy.

In most cases, the cause is a burst hemorrhoid. But excessive blood could indicate bleeding in the colon, Crohn's Disease or the presence of tumors or polyps.

"Frequently, blood in the stool has benign causes," Chang said. "But the doctor, not the patient, should determine that."

A change in the consistency of the stool -- prolonged periods of diarrhea, for example -- can be a symptom of Crohn's Disease or other inflammatory bowel conditions that often can be treated with drugs or diet.

While diarrhea is more common in children than adults, it signals that the intestines are inflamed and something is not right.

"I had a patient in the hospital who talked about having diarrhea for a month, and it turns out he had colon cancer," said Dr. Bob Carroll, a gastroenterologist and professor at the University of Illinois-Chicago.

Unusual poo hue can be another warning sign. While eating certain foods can lead to temporary discoloration -- beets can turn bowel movements red, and iron or Pepto Bismal can turn it black -- black, tarry bowels can indicate bleeding intestines.

A white or tan color with a clay texture can be a symptom of hepatitis or liver disease, and a creamy yellow color could signal that the body's having a problem absorbing fats.

Loose stool can be a sign of everything from wheat allergies to colitis, an inflammation of the lining of the large intestines, doctors say.

Constipation -- which is something two-thirds of people over 65 suffer from -- is often the result of a poor diet or a lack of activity. It's also a side effect of numerous medications.

"Bowel habits change as you age," Carroll said.

Whatever the symptoms are, early detection is key.

"With a lot of diseases, you don't get an early warning. But a little bleeding or a change in bowel habits could be an indicator," Hoscheit said. "It's like the light on the dashboard of your car. If you find something early, that'll help. Your body is trying to tell you something."

Doctors suggest people pay attention to what's in your toilet -- not too obsessively -- and be aware of pattern changes.

If you're over age 50, have regular colonoscopies, a key way to find cancer in its early stages. Next month is Colon Cancer Awareness Month.

"Having good (gastrointestinal) health and good poo practices can make you feel better overall," Sheth said.



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