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Gray bowels: What the Color and Consistency of Your Poop Says About You

What the Color and Consistency of Your Poop Says About You

While talking about your poop may feel like a taboo topic, here’s the thing — we all do it. In fact, your bowel movements can give you great insight into your digestive health. Jess Bailey, ARNP, and Kendra Ulicki, ARNP, UnityPoint Health, explain how the color and consistency of your stool can give you clues about what’s happening in your gut.

Bowel Movement Basics

Bowel movements occur at the very end of the digestive process and are one of the best indicators of whether your body is correctly digesting food.

What Does My Stool Color Mean?

Stool colors reflect how fast the stool passed through the intestines, what foods, medications or nutrients you recently consumed and the general gut health of your digestive system.

Light to Dark Brown Poop

Poop is normally brown and mimics the color of a milk chocolate bar. Bowel movements achieve this color through a complicated process. A pigment, called bilirubin, is created when a protein, called hemoglobin, breaks down in the liver. From there, bilirubin enters the intestines, and if a healthy digestive system allows it to travel through the intestines at a normal speed, it achieves the typical brown color of poop.

Green Poop

Green poop is more common than you might think and can be caused by a few different things. Bile, which is created in the liver and stored in the gallbladder, is naturally green. It’s present alongside stool in the intestines. If poop moves through the intestines too fast, the bilirubin and iron don’t have enough time to mix and complete the process of turning your stool brown.

Other reasons for green poop: Outside of moving through your gut too quickly, green poop can be caused by iron supplements, eating a lot of dark leafy greens, like spinach, antibiotics and other medications, having too many foods with green-colored dye, bacterial or viral infections and gastrointestinal disorders like Chron’s or celiac disease.

Black Poop

Black stool can mean there’s dried blood present in your poop, and internal bleeding occurred somewhere in the upper gastrointestinal tract — far enough away from the rectum that the blood had time to dry. Call your doctor if you notice you have black stool. This can be a sign of a serious digestive problem.

Other reasons for black poop: Iron supplements can cause black poop as well as eating a lot of black-colored food or consuming bismuth subsalicylate, an ingredient found in Pepto Bismol.

Yellow Poop

Poop can be yellow when fat isn’t absorbed from the stool. Fat absorption can be disrupted by parasites, illnesses or congenital diseases causing inflammation in the pancreas. Yellow poop is usually a sign of a medical problem that needs attention. If your yellow stool is present for more than two days, contact your doctor.

Yellowish, brown-colored stool, or pale poop, can sometimes be confused for yellow poop. The difference is subtle but noticeable. Yellowish brown-colored or pale stool has more of a gray tint and is less slimy.

Other reasons for yellow poop: Iron supplements can cause black poop as well as eating a lot of black-colored food or consuming bismuth subsalicylate, an ingredient found in Pepto Bismol.

Pale White Poop

Pale poop can look white, gray or like the color of clay. Pale poop is present when the liver doesn’t release enough bile salts into the stool in your intestines. This may occur due to bile duct blockages, gallstones or liver problems. Pale gray stool is usually a sign of a more serious problem. If your stool remains either of these colors for two days, contact your doctor.

Red Poop

Bright red poop is usually a sign of bleeding in the lower intestine. While the most common cause of red poop is hemorrhoids, it can also indicate inflammatory bowel disease, diverticulitis, polyps or an infection in the intestines. Contact your doctor if you have blood in your stool.

Other reasons for red poop: Food with red coloring, like fruit punch or Jell-O, can also temporarily add a tinge of red to stool.


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What Does the Shape and Consistency of My Stool Say?

Similar to what determines stool color, the consistency and shape of stool can be influenced by diet, fluids, medications, exercise and how much time poop spent in the intestines.

Hard Poop – Type 1

Hard poop happens when you’re constipated. It’s passed in separate, hard lumps, similar to pebbles. Hard poop likely sat in the large intestine for a while. During an extended stay in the colon, water and nutrients are removed from the stool, causing it to harden and break apart into pebbles. This type of stool also lacks the healthy bacteria found in poop that’s housed in the colon. Since the bacteria is missing, there’s nothing to retain water, which makes poop soft.

Firm Poop – Type 2

Firm poop that’s connected and lumpy is another sign of constipation. This type of stool spent too much time drying in the intestines but didn’t dry enough to break into small pieces.

Type two poop often hurts the most when passed since it’s usually large and firm. In order for the stool to take this lumpy, sausage-shaped form, it needs to have been in the colon for a few weeks.

Cracked Poop – Type 3

Stool that’s shaped like a sausage with cracks on the surface is typical of a poor diet or sitting too much. A form of poop most often seen with organic constipation (constipation caused by lifestyle or diet), cracked stool has been in the bowels for about a week before passing.

Healthy Poop – Type 4

Healthy poop is shaped like a sausage, about the width of a banana and between four to eight inches long. It remains intact when flushed and has the right amount of water and nutrients when passed. It resembles soft-serve ice cream. Having normal, healthy bowels means pooping every one to three days, too.

Soft Blob Poop – Type 5

When stool passes in the form of soft blobs with defined edges, it’s slightly loose. It’s common for people who have bowel movements two to three times a day. This type of bowel movement usually follows major meals. Soft, blob-shaped poop quickly passes without any strain or effort.

Mushy Poop – Type 6

Mushy stool with fluffy pieces that have a pudding-shaped consistency is an early stage of diarrhea. This form of stool has passed through the colon quickly due to stress or a dramatic change in diet or activity level. When mushy stool occurs, it’s hard to control the urge or timing of the bowel movement.

When the body is under stress or not used to a healthy diet and lifestyle, it can push poop through the intestines faster than intended. If the stool doesn’t spend enough time in the intestines, it hasn’t undergone normal processes, meaning, it still has water and nutrients that haven’t been extracted from the body yet.

Liquid Poop – Type 7

Liquid poop is an advanced stage of diarrhea. It has no solid form and passes without control. Diarrhea occurs when the small intestine is irritated, forcing liquid into the intestine to flush out of the body without being properly processed. Liquid can be absorbed by the large intestine, too, but most pools in the rectum, causing explosive diarrhea.

Concerned About the Color or Consistency of Your Poop?

It’s normal to feel uncomfortable or embarrassed when your bowel movements are out of whack, but the exam room is a safe space. It’s important to let your doctor know if you suspect a problem with your digestive health. You can call or schedule an appointment through our patient app, MyUniytPoint.

Stools – pale or clay-colored Information | Mount Sinai

Stools that are pale, clay, or putty-colored may be due to problems in the biliary system. The biliary system is the drainage system of the gallbladder, liver, and pancreas.

Food passes from the stomach into the small intestine. In the small intestine all nutrient absorption occurs. Whatever has not been absorbed by the small intestine passes into the colon. In the colon most of the water is absorbed from the food residue. The residue is then eliminated from the body as feces.


The liver releases bile salts into the stool, giving it a normal brown color. You may have clay-colored stools if you have a liver infection that reduces bile production, or if the flow of bile out of the liver is blocked.

Yellow skin (jaundice) often occurs with clay-colored stools. This may be due to the buildup of bile chemicals in the body.


Possible causes for clay-colored stools include:

  • Alcoholic hepatitis
  • Biliary cirrhosis
  • Cancer or noncancerous (benign) tumors of the liver, biliary system, or pancreas
  • Cysts of the bile ducts
  • Gallstones
  • Some medicines
  • Narrowing of the bile ducts (biliary strictures)
  • Sclerosing cholangitis
  • Structural problems in the biliary system that are present from birth (congenital)
  • Viral hepatitis

There may be other causes not listed here.

When to Contact a Medical Professional

Contact your health care provider if your stools are not the normal brown color for several days.

What to Expect at Your Office Visit

The provider will perform a physical exam. They will ask questions about your medical history and symptoms. Questions may include:

  • When did the symptom first occur?
  • Is every stool discolored?
  • What medicines do you take?
  • What other symptoms do you have?

Tests that may be done include:

  • Blood tests, including tests to check liver function and for viruses that might affect the liver
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Imaging studies, such as an abdominal ultrasound, CT scan, or MRI of liver and bile ducts

Korenblat KM, Berk PD. Approach to the patient with jaundice or abnormal liver tests. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 138.

Lidofsky SD. Jaundice. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 21.

Marks RA, Saxena R. Liver diseases of childhood. In: Saxena R, ed. Practical Hepatic Pathology: A Diagnostic Approach. 2nd ed. Philadelphia, PA: Elsevier; 2018:chap 5.

Last reviewed on: 7/30/2022

Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.


Irritable bowel syndrome (IBS) is a disorder of the motor-evacuation function, manifested by abdominal pain and / or defecation disorders. IBS develops as a result of psychological, visceral and other effects on the overreacting intestines.


IBS is the most common disease of the internal organs. According to our data, 26.2% of the working population suffer from it [1]. It can appear at any age, including in children. IBS is 2-3 times more common in women.

Despite the extreme prevalence of IBS, approximately 75% of the adult population do not consider themselves ill and do not seek medical help. The exception is people with deviations in the psycho-emotional personality profile. Psychopathological disorders are characterized by a shallow level of damage (neurosis and neurotic reactions). In some patients, endogenous psychoses are possible (schizophrenia, circular psychosis, involutional melancholy, etc.). Concomitant psycho-emotional disorders aggravate the course of IBS and lead to a decrease or even loss of ability to work. As a rule, IBS in these cases is difficult to treat. The quality of life of such patients is so low that it can be compared with the quality of life of patients with type 1 diabetes mellitus. Often such patients have some kind of endogenous disease and are subject to examination and treatment by a psychiatrist. The vast majority of patients with IBS have psychopathological disorders of a shallow level, such patients are under the supervision of a general practitioner and a gastroenterologist.

Etiology and pathogenesis

In the etiology and pathogenesis of IBS, psychoemotional disorders are important. The role of psycho-emotional disorders is confirmed by the following observations:

  • patients with IBS who visit doctors have a history of chronic stress;
  • when examined by a psychoneurologist, neuroses, neurotic personality development or psychopathy are detected;
  • in all patients with IBS, vegetative disorders are observed with a predominance of parasympathetic influences.

The importance of intestinal infections in the etiology of IBS is confirmed by the fact that in about 30% of patients the onset of the disease was preceded by an acute intestinal infection. In the pathogenesis of chronic disease, intestinal dysbacteriosis and damage to the enteric nervous system by antigens of acute intestinal infections are of great importance [2].

Clinical picture

The leading symptoms of IBS are pain, abdominal discomfort, and stool disorders. Often in the stool one can see a large amount of mucus, the secretion of which is stimulated by the influence of parasympathetic innervation on the function of goblet cells. On examination, a spasmodically contracted painful colon is palpated. Spasm of various parts of the colon, as well as pain on palpation, is observed inconsistently and can change localization on different days.

Patients with IBS have many extraintestinal symptoms, some of which are associated with dysfunction of other digestive organs, and others with disorders of the autonomic nervous system and psychological status. The latter cause fatigue, weakness, headaches, decreased appetite, sleep disturbances, paresthesia, palpitations, sweating, attacks of “lack of air”, frequent urination, low-grade fever, etc. Often, patients suffer from cancerophobia.

There are three main types of IBS: constipation-dominated, diarrhea-dominant, and pain-dominant.


The diagnosis of IBS can be made on the basis of typical clinical symptoms in the absence of other bowel diseases that are ruled out by additional investigations. Anal sphincter spasms and tenderness are often observed during a proctological examination. Colonoscopy reveals intestinal hyperkinesia of the spastic type. Persistent spasm often prevents the introduction of the endoscope and is the cause of significant pain. The intestinal mucosa looks somewhat edematous, hyperemic, often with mucus overlays on the walls of the intestine. The folds are thickened and rough due to the increased tone. We noticed that changes in the intestine in patients with IBS are transient and often not detected during the removal of the device from the intestine. Examination with a barium enema often reveals dyskinesia and an increase in the number of haustrations [3].

The clinical criteria for IBS have evolved over time. Currently, for the diagnosis of IBS in adults, the “Rome criteria-II (2000)” is used [4].

Rome Criteria II (2000)

For at least 12 (not necessarily consecutive) weeks in the last 12 months, there has been abdominal discomfort or pain that has at least two of the following three characteristics:

  • decrease after defecation;
  • onset is associated with a change in stool frequency;
  • the onset is associated with a change in the shape of the stool.

Thus, the clinical diagnosis of IBS is based on the identification of functional disorders in the patient associated with the work of the intestine. IBS is diagnosed only if there is an association of pain and discomfort in the abdomen with stool. Symptoms appear before the stool and subside after a bowel movement, and there is a dependence on changes in the regularity or consistency of the stool.

To prevent diagnostic errors, attention should be paid to a number of symptoms that are not characteristic of IBS, which may indicate the presence of organic diseases (the so-called “alarm” symptoms or “red flags”).

Anxiety symptoms
  • Rectal bleeding
  • Weight loss
  • Chronic diarrhea
  • Anemia
  • Fever
  • Onset in persons over 50 years of age
  • Family history (cancer and inflammatory bowel disease in parents)
  • Pain and diarrhea at night

However, the presence of symptoms of “anxiety” is not yet a reason for exclusion in such patients with IBS. So, the onset of the disease in people older than 50 years is quite possible, but this requires a mandatory instrumental examination. Rectal bleeding may be due to hemorrhoids; weight loss and subfebrile temperature are manifestations of depression or hypochondriacal syndrome.


A differential diagnosis should be made if the following conditions are present:

  • malabsorption diseases;
  • inflammatory bowel disease;
  • intestinal tumors;
  • endocrine enteropathies;
  • hypolactasia and other types of disaccharidase deficiency.

The differential diagnosis of IBS with diseases of the small intestine should be based on the exclusion of malabsorption symptoms characteristic of the pathology of this part of the intestine. Malabsorption syndrome is manifested by quantitative (deficiency in body weight) and qualitative (trophic disorders) malnutrition.

In IBS, there is often a lack of body weight, but it is not associated with a violation of the assimilation of nutrients, but with features of the neuropsychic status or with poor appetite. There are no qualitative trophic disorders in patients with IBS.

Qualitative malnutrition is manifested by dryness and flaking of the skin, a change in its color (a kind of dirty gray shade), the appearance of age spots on the face, hands and legs, and other trophic disorders. In contrast to the diarrhea associated with malabsorption in IBS, stools are scanty in volume.

Differential diagnosis with inflammatory diseases is based on the correct interpretation of the results of instrumental studies, including biopsy. Unlike inflammatory diseases, IBS never has blood in the stool.


Treatment of IBS should be comprehensive and have an impact on the main pathogenetic mechanisms.

Health food. Patients with a predominance of constipation are shown diet No. 3 with the addition of wheat bran. In the case of the predominance of diarrhea during an exacerbation, it is recommended to limit foods rich in fiber (diet No. 4c).

Correction of psycho-emotional disorders. The treatment of patients with concomitant neuroses and other abnormalities in the psycho-emotional status should involve a psychoneurologist or psychotherapist who knows the methods of psychotherapy and psychotropic pharmacotherapy. A set of measures aimed at improving the functions of the central nervous system and correcting autonomic disorders includes psychotropic drugs, rational psychotherapy, and hypnosuggestive effects. Ideally, psycho-emotional disorders should be diagnosed and eliminated by a neuropsychiatrist or psychotherapist, or, even better, a specially trained gastroenterologist.

Antibacterial and bacterial preparations. Antibacterial drugs are prescribed to most patients with IBS in order to rid the body of pathogens of acute intestinal infections during their long-term persistence in the intestine (including in the intestinal wall), to suppress excessive bacterial growth in the upper sections of the small intestine and to eliminate colon dysbacteriosis [5].

Clinical indications for the use of antibacterial drugs in IBS are diarrhea, flatulence, and abdominal pain. Apply antibacterial drugs in courses of 7-10-14 days.

Biseptol (septrin, bactrim), furazolidone, ersefuril, metronidazole (trichopolum), as well as oxyquinoline derivatives, quinolones intetrix, nitroxoline and nevigramon are recommended.

After antibiotic therapy, a long-term (up to 1.5-2 months) intake of bacterial preparations (probiotics) is recommended: bifidum- and lactobacterin, bifiform, hilaka-forte, etc.

Regulators of the motor-evacuation function of the intestine. Diarrhea is symptomatic with imodium (loperamide) and alosetron, a selective competitive serotonin 5-HT3 receptor antagonist.

Patients with a predominance of constipation are shown prokinetics Cerucal and Motilium. With persistent pain, antispasmodics pinaverium bromide (dicetel) – the prototype of a new class of Ca2 + antagonists – and duspatalin (mebeverine) have a good effect.

Symptomatic remedies. All patients with IBS during exacerbation of diarrhea are prescribed astringent, antispastic, enveloping and neutralizing organic acids drugs: smectite, bismuth nitrate, dermatol, tanalbin, white clay, calcium carbonate, as well as herbal decoctions of a similar effect (chamomile, peppermint, St. John’s wort, alder cones, blueberries and bird cherry). For a similar purpose, you can use some antacids (almagel, phosphalugel, maalox) and drugs containing bismuth (venter).

In IBS with a predominance of constipation, it is necessary to teach patients how to develop the lost morning reflex to defecate and increase the amount of dietary fiber in the diet by introducing wheat bran into it. To stimulate defecation at the first stage of developing a lost reflex, duphalac (lactulose) 1-2 dessert spoons should be prescribed the night before. Duphalac has a mild laxative effect, based on an increase in osmotic pressure in the intestinal lumen, and does not irritate its overly sensitive receptors. In addition, dufalac reduces the pH of the medium in the intestine and promotes the growth of acidophilus bacteria.

The condition of patients with IBS, the effectiveness of treatment and prognosis largely depend on the severity of concomitant psychopathological manifestations. In achieving a stable clinical remission, overcoming intra-family, social and social conflicts, which are the cause of the formation of a neurosis in a patient, is often of decisive importance.

The working capacity of patients with IBS and the prognosis for this disease largely depend on the severity of concomitant psychoemotional disorders.

For literature inquiries, please contact the editor

Intestinal melanosis – Adamant Medical Clinic

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Intestinal melanosis is a benign disease characterized by excessive accumulation of the coloring pigment lipafuscin in the walls of the organ. It is because of it that the inner surface of the intestine with melanosis acquires a characteristic dark color (from brown to black).

For the first time, the disease was described in the middle of the 19th century by the French doctor J. Cruvelier. Pathology often occurs in old age and mainly in women. The disease develops against the background of chronic constipation, if patients uncontrollably and in large quantities take laxatives containing antraglycosides (herbal preparations).

Melanosis, as a rule, proceeds without pronounced symptoms and is diagnosed during a routine preventive examination of the intestine, or during an endoscopic examination for another disease of the colon. Pathology is expressed in focal or diffuse staining of the mucosa of the organ in a dark color. Although oval nodular accumulations of lymphoid tissue and solitary lymphatic follicles of the intestine retain their usual color.

Diseases of the liver and pancreas, colon cancer can increase the severity of the pathology. In some cases, there may be darkening in all parts of the colon.

Below are images of the colonic mucosa in normal and melanotic cases:

In most cases, patients with melanosis complain of chronic constipation and regularly abuse large doses of laxatives. Effective treatment with the withdrawal of laxatives in such patients can lead to the complete disappearance of the disease.

It is important to understand that self-medication of diseases of the gastrointestinal tract and the abuse of drugs is unacceptable. If you are concerned about long-term, especially growing, constipation, medicines should be taken only after consulting a specialist (gastroenterologist, surgeon) and a qualitative examination of the colon, so as not to miss the organic cause of constipation (large polyps, tumors).

To date, the most informative method for examining the colon is the colonoscopy procedure. It allows to detect intestinal pathology at the earliest stages, to carry out therapeutic manipulations in the intestine, to take materials for histological examination.

Aleinikov Anton Vladimirovich ,

head of the endoscopic department of the Adamant Medical Clinic

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