Tackling the Poo Taboo!
(CAUTION: this post is not for those with TMI objections!)
So you’re sitting with your doctor, or your naturopath/homeopath/acupuncturist/therapist, whatever the case may be, and the time has come to stop beating around the bush (where you have been discussing your “funny tummy”) and actually get to the crux of the matter: poop!
How are you supposed to talk about poop (and your own poop no less) without cringing, giggling, squirming, blushing, or just generally feeling awkward and embarrassed? Some people have more trouble with this than others. So here is a guide to the basics - may it help enable you to talk to whoever you need to talk to, in an effective manner, so as to be able to get the help or treatment that best suits your particular situation.
What it's all about: Poop
Starting with the basics, you may find it easiest to refer to your ‘produce’ as stool(s), as opposed to the eternal classics of poo, crap and shit. If you’re feeling particularly official and scientific, how about faeces?
So much for the noun, now we come to the verb, the process itself. You could simply go with going to the toilet. Or, there is also bowel movement (or BM for short), or bowel evacuation, though I find the latter has a feel of national emergency about it and conjures up images of some sort of mass exodus within the intestinal walls, but that’s just me!
Frequency
This one is pretty straightforward as it’s simply the number of times you go in a 24-hour period. It’s useful to know your average for when you are talking with your doctor, as well as how many times are involved on a typical ‘good’ day, and on a ‘bad’ day (obviously this does not apply to a flare-up, which is of course back-to-back bad days).
Consistency
Getting to the nitty gritty now. Some useful, and self-explanatory, terms are quite simply: watery, loose, semi-solid, solid, soft or hard.
The doctor of a good friend of mine, whose bowel issues are the symptom of another condition, tried to be helpful and suggested porridge as a description! Whatever works for you.
Alternatively, and leaning more towards doctor-speak, there is the Bristol Stool Chart, available for your perusal following a simple Google search.
Photo credit: DrJohnBullas via Visualhunt / CC BY-NC-ND
Armed with this chart, you can comfortably answer this question with a “Bristol number x” and be done with it. (Fun fact: "off to Bristol" is one of the many euphemisms for doing your business - this is why!)
On a separate note, a quick Google has just shown me an alarming number of ‘Bristol Stool Scale’ cakes – yes, cakes! I can only assume this is some kind of medical student humour…Also available are BSS mugs, canvas bags, thermos and phone cases!
Pain
The most annoying of questions: “what kind of pain?” Answer: “The kind that hurts!!”
While answering in this manner is totally understandable, it is entirely unhelpful. It took a long time for me to be able to distinguish the various categories of pain, and I’m still not sure I’ve identified all of them. Here’s what I have:
Discomfort – not pain exactly, but it’s when you don’t feel right, something feels ‘off’ and uncomfortable, difficult to pinpoint. Discomfort is commonly what you feel when you are bloated, for example.
Localised/general – localised pain is restricted to a particular spot or small area, while generalised pain is usually felt in the entire abdominal area.
Dull pain or ache – this pain can often be ignored. It’s usually constant and fairly low-level and is the kind of pain that may prompt you to place your hand over your tummy and maybe even do a gentle belly rub.
Acute/sharp – as in, like a knife or skewer, impossible to ignore, usually localised, as opposed to the general abdominal area. Can be constant or momentary (constant acute pain is often a sign something is really wrong so don’t try to power through it if it’s not going away).
Deep/shallow – these two opposites are fairly self-explanatory. Shallow pain is felt on the surface or just below it, and deep pain is felt further inside.
Constant/transitory/waves – constant pain is obviously pain that does not go away, nor is it relieved when you change position. Transitory pain comes and goes, and is sometimes dependent on your physical positioning. Waves of pain are felt just as one might imagine, starting mildly and building up to the peak and then dropping back down again until it fades away. Waves can be quick or slow, and the point of most pain can vary – you can have waves of mild pain or of acute pain, for example.
Pressure – fairly self-explanatory again, a helpful visual is one of someone pushing the particular area, either from the outside or inside. If you suffer from haemorrhoids for instance, you may feel pressure inside the rectum.
Stabbing – this is a localised type of sudden and quick transitory pain, sometimes involving quick successive pulses of pain, or stabs spaced farther apart. It can be sharp, like a knife, or more like a poke.
Spasmodic – a bit like stabbing pain, but less localised. It can be crampy and is typically on-and-off.
Shooting pain – this is sudden and momentary pain, which feels like it is moving from one point to another (the two points are not necessarily that far apart), unlike stabbing pain, which is localised.
Burning pain – this can be burning, as in heat, or as in acid. Can be long-lasting and difficult to get rid of. Frequently experienced with acid indigestion, GERD, or with haemorrhoids.
Scratchy – this pain is what I would imagine it would be like to swallow a pinecone! Whether it’s in your oesophagus, stomach, tummy, or during a bowel movement: you feel like something is scratching you as it passes through you.
Griping – the best way I can describe this pain is to imagine that someone has stuck their hand into your abdomen, closed their fist around your insides, and is rotating their wrist. Graphic, I know, but it gets the message across. This pain is frequently accompanied by abdominal cramps, and is a classic IBS symptom (not to mention IBD).
Fixed/moving – fixed pain is restricted to a specific spot or area, and moving pain shifts around, as when you have trapped wind making its way through your gut.
Bruising – a type of dull ache, but one that makes you think of a bruise, like someone has punched you.
Throbbing/pulsing – like a painful heartbeat, but in your digestive system!
Blood
Is there blood, or isn’t there? If yes, is it a lot? Obviously it is hard to pinpoint exact amounts of any blood lost, but try to guess – does the toilet resemble a massacre site or are we talking droplets? Do you see it in the toilet bowl or on the tissue? Is it running through the stool or separate from it?
When it comes to consistency, is the blood liquid or sticky and clot-like?
Next up is the colour – is the blood dark, almost black? It is a bright red? Pale pink? The colour generally determines what part of the digestive tract the blood has come from: dark blood either originates further up the tract (even in the stomach in the case of a stomach ulcer), or from an active ulcer in the intestine. Redder and brighter blood is usually from lower down the tract, frequently from haemorrhoids or fissures.
Finally, how often do you see blood?
Details
Some extra details that are relevant include the presence of any undigested food, whether or not mucus is present, and, rather unfortunately, smell!
The easiest way to deal with the smell question is to use terms such as malodorous, mild, strong/intense, or nothing noteworthy.
As for mucus, the first time I was asked about it I was thoroughly confused – “mucus is in your nose, what would it be doing in the loo?!” But yes, when you have IBD, your intestines (a mucous membrane, like the inside of your nose), produce an excess of mucus in an effort to form a protective coating over the intestinal lining. Excess inflammation triggers this process, so mucus in the stool is indeed a sign of this inflammation.
(Random trivia: for anyone wondering about the issue of mucus vs mucous, 'mucus' is the noun for the slimy stuff, and 'mucous' is the adjective describing the membrane.)
Other feelings
While discussing your bathroom activities, don’t forget to mention any other things that are troubling you, such as nausea, fatigue, light-headedness, any joint pain, headaches etc. They might not be related to what’s going on in the gut, it’s true, but a lot of the time they really are, whatever the gut issue may be.
So that pretty much sums it up. I hope you may find something helpful here for the next time you need to tackle the poo taboo. Furthermore, always remember that your doctor chose their profession, while you did not choose your health problem. Gastroenterologists actively chose to spend their professional life dealing with that particular part of the body and its produce – it’s their own fault! So don’t feel awkward or embarrassed when you need to share relevant information with them.
During one particular appointment with my gastro, many moons ago, I simply couldn’t help myself and I asked him why he wanted to be a gastroenterologist, to which he responded “If there weren’t gastroenterologists, who would look after people like you?” I did not consider this to be a valid reason and hit back with, “Yes but I did not choose my disease. I didn’t select intestinal woes from a list of options, but you CHOSE to work with bottoms!” He looked at me rather strangely then, and said “You know, I’ve never thought about it like that before”…Weirdo!