Running with Crohn’s: Everything comes down to ... Poo!

Running with Crohn’s: Everything comes down to Poo

First some silliness:

J.D.: Hey, Ms. Miller -- we just need a stool sample
Patti: Why do you need a stool sample if you think I'm just a nut?
Turk & JD: 'Cause the answer's not in your head, my dear -- it's in your
butt!

J.D.: You see…
Everything comes down to poo!
From the top of your head, to the sole of your shoe
We can figure out what's wrong with you by lookin' at your poo!
Turk?

Turk: Do you have a hemorrhoid or is it rectal cancer?
When you flush your dookie down, you flush away the answer!

J.D.: It doesn't really matter if it's hard or if it's loose
We'll figure out what's ailing you, as long as it's a deuce!
Yes!
Everything comes down to poo!

Nurses: Everything comes down to poo!

J.D.: Cardiovascular and lymphatic, yes, the nervous system, too!
All across the nation, we trust in defecation!
Everything comes down to poo!

Turk: If you want to know what's wrong, don't sit and act so cool
Just be a man and eat some bran, and drop the kids off at the pool!

Robed Woman: My stomach hurts
J.D: Check the poo

Limping Woman: I sprained my ankle
Turk: Check the poo!

Bloody Shoulder Guy: I was shot!
J.D: Check the poo!

Delivery Guy: A homeless guy threw poo in my eye!
Turk: Check the poo!
Delivery Guy: Mine or his?
J.D: First him, then you!
It may sound gross, you may say "shush!"

J.D. & Turk: But we need to see what comes out of your tush!
Because!

All: Everything comes down to poo!
Whether it's a tumor or a touch of the flu!

J.D. & Turk: Please, won't you pinch us off a big, fat clue!

Turk: Our number one test is your Number Two!

All: If there's no breeze, light a match please!
Everything comes down to --

J.D.: Doo-doo!
Turk: Doo-doo!
J.D.: Doo-doo!
Turk: Doo-doo!

All: Everything comes down to ... poo!

"Everything comes down to poo" lyrics from SweetLyrics

"Everything comes down to poo" video from YouTube

Now some seriousness:

Seriously, I will discuss poop in this entry.  If you think this might bother you, then stop reading now and go on to the next entry.

Everyone who suffers from Inflammatory Bowel Disease (also called IBD), which consists of both Crohn’s Disease and Colitis, or Irritable Bowel Syndrome (also called IBS) deals with poop, a lot.  That poop can tell you something about the state of your bowels, so I highly recommend that you visually inspect your stool after each bowel movement.

Diarrhea

I learned something new today.  Diarrhea is defined as passing three or more stools per day and does not depend upon the consistency of the stool.  People with IBD and IBS suffer from diarrhea nearly 100% of the time.

On a typical day, I pass stool about 4-8 times and this is typical for IBD and IBS patients.  On rare occasions that I do not suffer from diarrhea, I am usually suffering from a bowel obstruction.  During last week’s partial bowel obstruction, nearly 36 hours passed between bowel movements (rare for me) and I suffered from a lot of pain.

Consistency

British doctors developed a 1 – 7 scale to grade stool consistency.  A “1” represents poop so hard it comes out feeling and looking like pebbles.  A “7” represents a stool so loose that it is literally like water (with now discernible texture) – the same consistency as stool passed at the end of a bowel preparation for colonoscopy.

People suffering from IBD or IBS typically pass stools that rate from 4 to 7 on this scale.  Personally, I extremely rarely pass stools lower than a four and usually rate a 5, 6, or 7.  When I pass a stool that would rate a 4 or lower, it is remarkable enough that I tell my wife about it.

Color

The color of your stool can tell you more about your bowels.  The chart below shows stool colors and what those colors indicate about you.

Stool color	Indicates	See Dr?	Have I experienced this?
Brown	Normal	No	Common for me
Green	Excess bile, normal	No	Common for me
Yellow	Possible infection	Yes, if it is unusual	Common for me
Black	Intestinal bleeding in upper GI tract, associated with anemia and active disease	Yes, if it is unusual	Uncommon for me
Red	Intestinal bleeding in lower GI tract, associated with anemia and active disease	Yes, if it is unusual	Rarely (now common)
White	Biliary obstruction	Yes	Never
Blue	Ingestion of blue die	No	Never
Silver	Biliary obstruction with bleeding	Yes	Never

Stool color information from Wikipedia 

Update June 26, 2015: Since originally creating this table, I have started having blood (red) in my stools on a regular basis - at least once per day for the last 6 months.  I estimate that I'm losing about 1-2 tablespoons of blood per day this way.  I've informed my doc but he doesn't seem too concerned.  I'm not displaying signs of anemia.

A short note on green stools

The terminal ileum (last segment of the small intestine) absorbs bile released at the beginning of the small intestine.  This segment absorbs vitamin B-12 and is the portion most often affected by Crohn’s Disease.  If you regularly pass green stools, it may indicate that the disease or treatment of the disease has impaired the function of this part of your intestine.  You may want your doctor to test your blood for your nutrient levels, especially vitamin B-12.

Since my surgeon removed my terminal ileum in 1998, about 50% of my stools are green.  In addition, my blood serum levels of B-12 dropped below recommended levels and so I now self-inject B-12 to keep my B-12 levels in an acceptable range.

Excessive bile in your stool can trigger diarrhea in normally healthy people (bile is an irritant to the large intestine).  If you consistently pass green stools and do not suffer from bowel disorders, you may ask your doctor about Questran powder (generically called cholestyramine).  It absorbs bile in the digestive tract, helps lower your cholesterol, and helps bind your stool.

Also, note that your large intestine will gradually develop a tolerance for bile in your stool.  Therefore, you can eventually wean yourself off the use of cholestyramine powder.  It took me nearly 5 years to do that.

Odor

People who suffer from bowel disorders (IBD, infections, Celiac’s Disease, short bowel syndrome, etc.) commonly produce stool and gas with more and worse odor.

Cleaning

Because people with bowel disorders pass stools far more frequently than normal, they also need to work harder to keep clean.  Unfortunately, all toilet paper is mildly abrasive.  Using even the softest and most forgiving toilet paper 8 times per day makes our nether regions sore and can cause bleeding.

I solved this problem by switching to a generic version of PreparationH wipes.  These wipes successfully clean my rectal area far more thoroughly than toilet paper ever could and they do so with a single wipe.  Furthermore, they contain Witch Hazel (an astringent) that helps heal any superficial abrasions from the frequent use of toilet paper.  This product MAY be used with both city sewer and septic tanks.

Other stuff

Like other people with bowel disorders, my digestive system works very fast.  It takes only one or two hours for food to work through my intestines and appear in my stool.  Frequently, when I have consumed the barium milkshake die for imaging of my intestines, the die passes completely through my bowels in an hour or so (it may take four or more hours for a normal person).

If you suffer from strictures (from either disease or surgery) and recognize bits of vegetable matter in your stool, then you should reconsider what you are eating and how you are eating it.  Bulk vegetable matter causes my bowel obstructions.  When I recognize corn kernels, lettuce, spinach, or other vegetables in my stool, I consider it a warning that they could have caused a bowel obstruction.  I try to take these precautions at my next meal:

• Cut your vegetables into smaller chunks so you can consume smaller bits of vegetable matter
• Chew vegetables 20 times before swallowing
• Consume pureed vegetables
• Eat small amount of vegetables mixed with low residue foods¹
• Reduce my consumption of bulky, fibrous vegetables

¹ Low residue foods include foods with little fiber content, such as meat, eggs, starches, and fatty foods.