Changes in stool appearance, such as consistently flat or wide stool, can be concerning. While often benign and temporary, persistent alterations in stool shape warrant further attention. Understanding what constitutes typical stool can help in discerning when to consider these changes.
Understanding Normal Stool
Healthy stool is typically medium to dark brown, soft to firm, and passes as a single or few pieces. Its elongated, sausage-like shape results from formation within the intestines. Most individuals pass stool once daily, though a frequency ranging from every other day to three times daily can be normal.
The Bristol Stool Chart categorizes stool into seven types based on shape and consistency. Types 3 and 4 are generally considered ideal, appearing like a sausage with cracks or smooth and soft. These types indicate well-formed stool that is easy to pass without straining. Types 1 and 2, which are harder and lumpier, typically suggest constipation, while types 5 through 7 indicate looser stool or diarrhea.
Common Reasons for Shape Changes
Stool shape can vary due to non-serious factors, often reflecting daily habits or temporary bodily changes. Dietary factors play a significant role; a lack of fiber or insufficient hydration can lead to harder, more compacted stool. When stool is hard, it may flatten as it passes through the bowel. Straining during bowel movements, often due to constipation, can also compress the stool and alter its shape.
Temporary narrowing of the rectal or anal passage can also influence stool form. Conditions like hemorrhoids or anal fissures can briefly compress stool as it exits. Muscle spasms in the pelvic floor can also temporarily affect stool shape. Increased gas within the digestive system may contribute to variations in stool shape.
Potential Health Conditions
Persistent changes in stool shape can point to underlying medical conditions affecting the digestive tract. Colonic strictures, narrowings of the colon, can impede stool passage, causing it to become thinner or flatter. These strictures may arise from inflammation, such as in Crohn’s disease or diverticulitis, or from scar tissue due to prior surgery.
Growths within the colon or rectum, such as polyps or tumors, can physically obstruct the bowel, leading to flat, ribbon-like, or pencil-thin stool. These growths can reduce the space available for stool to pass, forcing it into an altered shape. Irritable Bowel Syndrome (IBS) is another condition that can lead to changes in stool shape, including flat or ribbon-like appearances, especially during phases of severe constipation or diarrhea. Inflammatory Bowel Disease (IBD), encompassing conditions like Crohn’s disease and ulcerative colitis, can cause chronic inflammation and structural changes in the intestinal walls, potentially affecting stool consistency and shape.
When to Seek Professional Guidance
While occasional changes in stool shape are common and usually resolve on their own, certain signs indicate that professional medical evaluation is advisable. If flat or wide stool is a new symptom and persists for more than a few days or a couple of weeks, it warrants medical attention. Persistent changes in stool appearance should prompt a discussion with a healthcare provider.
It is particularly important to seek guidance if changes in stool shape are accompanied by other concerning symptoms. These “red flag” symptoms include unexplained weight loss, new or severe abdominal pain, blood in the stool (which may appear bright red or black and tarry), or other significant changes in bowel habits like new onset constipation or diarrhea. A family history of colon cancer or inflammatory bowel disease can also increase the importance of timely evaluation for persistent changes.
Medical Evaluation and Next Steps
When seeking medical attention for persistent changes in stool shape, a doctor will typically begin by discussing symptoms, reviewing medical history, and conducting a physical examination, which may include a digital rectal exam. Further diagnostic tests may be ordered to identify the underlying cause.
These tests can include stool analysis to check for signs of infection, inflammation, or hidden blood. Blood tests can provide information about overall health and detect markers of inflammation or anemia. Imaging studies, such as CT scans, may be used to visualize the gastrointestinal tract and identify any structural abnormalities or obstructions. A colonoscopy is often considered the most definitive procedure, allowing direct visualization of the colon and rectum, enabling the detection and sometimes removal of polyps or other growths. Adopting a high-fiber diet, ensuring adequate hydration, and engaging in regular physical activity are general practices that support bowel health and may alleviate some non-medical causes of stool shape changes.