The Questions This Doctor Always Asks Her Patients About Their Poop

Photo: Marko Milanovic

It's amazing how uncomfortable many people get around poop. I know someone who will only do it in complete solitude, and I don't mean with the door closed—I mean alone in a building! In contrast, I'm "into" poop because it's such a critical component of health. It can tell you a lot about the balance of bacteria in your gut, how well you're absorbing nutrients, and whether your body is detoxifying toxins properly. As a result, it's always a big part of my standard work-up and evaluation in my functional medicine practice.

The questions I always ask my patients about their bowel movements.

So let's dive in; it's time to get personal! Here are three questions I always ask my patients about their bowel movements:

1. How often do you poop?

It always blows my mind when I ask my patient how often he or she is pooping and I hear "once a week" or "once every two weeks." I immediately know that this is someone with a challenged gut and a lot of work to do on their health. Unless you're fasting you're taking in food every day. Once you've gotten what you need from that food, you need some way to get rid of the waste. and you do this by having daily bowel movements! I remember laughing hysterically in medical school when I learned about the "oro-anal" response, which means that when you eat, it causes you to poop. When the gut is functioning normally, you should expect to have a bowel movement at least once a day, and up to four times in a day can be normal depending on its size and shape.

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2. What does it look like?

Size matters, people! What I'll call "bunny poops" (those hard little pellets) are not normal! Nor is diarrhea, watery stool, food particles, or pencil-thickness poops. The ideal poop looks like a pipe, and the thickness will vary based on your colon.

3. Does it require a lot of effort?

Many people don't know this, but it's not normal to have to strain. Pooping actually occurs when you relax; you need to relax the muscles to allow the stool to pass. Straining, pushing, or splinting aren't normal and can be addressed, depending on the underlying cause.

Here's why this is all so important—especially for women.

For women in particular, a dysfunctional gut can have terrible consequences for our hormones, mood, and skin, not to mention the risk of cancer. You see, in addition to food waste, our gut excretes the hormones that the liver has bound to and deactivated. What does this mean, exactly? Well, your body produces hormones, and the liver is responsible for processing and inactivating them. This happens in two phases: Phase I, which actually converts the hormone into a more toxic form, and Phase II, during which those toxic hormones are bound and deactivated so they can be moved out of the body. For most women, Phase I is a pretty quick process, and Phase II is typically slower. A problem occurs when Phase I is too quick. In this case the system is overloaded, and the body will store the toxic hormones in the fat cells, which can lead to a host of problems.

Once a hormone completes Phase II binding, it's put into the gut for excretion. And this is where you need to pay attention: If you are not having regular, normal bowel movements, the hormone just sits in the gut. When this happens an enzyme in the gut called "beta-glucuronidase" separates the hormone from its binder, and once the hormone has been cleaved from its binder, your body recycles the toxic hormone. For women, this is particularly worrisome and can lead to dysfunctions like menstrual irregularities, acne, mood disorders, and, most importantly, an increased risk of hormonally derived cancers like breast, uterine, ovarian cancers. This is why it's particularly critical for women to have effective gut function.

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