When should I see my doctor about changes in stools?

You should talk to your doctor if you have stool changes in any of the following:

Color

The color of stools varies, but typically falls within the spectrum of brown color, depending on the foods you eat. You should be concerned if your stools are deep red, maroon, black, or "tarry," especially if they have a noticeable odor. This may mean that there is blood in the stool.

Small amounts of bright red blood on stool or toilet paper are likely caused by hemorrhoids or a scratch in the rectal area, and generally should not cause concern. However, if more than a few bright red streaks are visible in the stool or on the toilet paper, or you develop bloody diarrhea, you should tell your health care provider.

In addition, pale stools that are clay or white in color and often accompanied by a change in urine color (dark urine) could indicate a problem with your biliary tree, such as bile duct stones, or liver-related issues. You should notify your health care provider or go to your local Emergency Department if you develop fevers, chills, right-sided upper abdominal pain, or yellowing of the skin.

Consistency (degree of firmness)

Stools should be soft and pass easily. Hard, dry stools might be a sign of constipation. You should notify your health care provider if constipation lasts longer than two weeks. Also, if you have nausea, vomiting, abdominal pain, and have not been able to pass gas or stools, this could mean that there is an obstruction (blockage). You should tell your health care provider or go to your local Emergency Department.

If stool becomes impacted (lodged) in the rectum, mucus and fluid will leak out around the stool, leading to fecal incontinence. Call your health care provider if you have mucus or fluid leakage from the rectum.

Diarrhea is bowel movements that are loose and watery. Diarrhea is a common condition and is usually not serious. You should call your health care provider if:

  • You have severe abdominal pain or discomfort with your diarrhea that does not go away when you pass stools or gas.
  • Diarrhea is accompanied by fever of 101 degrees or higher, chills, vomiting, or fainting.
  • Severe diarrhea lasts longer than two days in an adult, one day in a child under age 3, or eight hours in an infant under six months.
  • You develop severe diarrhea and have taken antibiotics recently.
  • You are elderly, were recently hospitalized, pregnant, or immunocompromised (take steroids, TNF-alpha inhibitors such as infliximab [Remicade®] or etanercept [Enbrel®], or transplant rejection medications).
  • You have diarrhea that lasts for more than two weeks.

Frequency

The normal length of time between bowel movements ranges widely from person to person. Some people have bowel movements several times a day, others only once or twice a week.

Going longer than three days without having a bowel movement is too long. After three days, the stool becomes harder and more difficult to pass. Constipation then occurs as bowel movements become difficult or less frequent. If you have constipation for more than two weeks, you should see a doctor so that he or she can determine what the problem is and treat it.

Only a small number of patients with constipation have a more serious underlying medical problem (such as poor function of the thyroid gland, diabetes, or colon cancer). For a patient who has colon cancer, early detection and treatment might be lifesaving.

You should also contact your health care provider if you have unexplained, sudden urges to have a bowel movement. This could be a sign of a mass in the rectum or inflammatory bowel disease.

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