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March 16th, 2020


Continuing on the dairy and outcomes storyline, let us review healthy bowel patterns. Bowel patterns are a great window into our nutritional and metabolic health. We all know the stool caliber of our diaper bound children, but we start to lose this knowledge around the 3 year old age range as our children begin to defecate on their own. Why does this matter?

As the microbiome data continues to push medicine into new understandings, bowel patterns are a great window into food reactions, food composition and thus nutritional and metabolic sufficiency.

A few obvious and frustrating events of childhood can easily be diagnosed by stool pattern and history.

The first is colic. These children present around 3-4 weeks of age with green runny stools associated with cradle cap, eczema and spitting up all tied with crying episodes. The green color is due to bile passing through the GI tract quickly and thus not being altered by enzymes. This is generally classic milk protein intolerance and easily cured with a dairy free maternal diet if breast feeding or dairy free formula. If a dairy free trial is not curative, then look at soy and corn as potential culprits. Powder based formulas use corn syrup solids as the sugar base.

The second is recurrent abdominal pain related to constipation. These children present at all ages and have hard bowel movements that are either extremely large or little hard nuggets that are a dark brown/black or green color. These children often consume lots of dairy and low fiber flour foods in their diet. Complete removal of dairy often cures 70% of these children and adults.

Based on these examples, what is a normal bowel movement for an infant? By three days of age an infant will have multiple yellow mustard seedy stools daily until they start to consume solids. Then it shifts to a formed brown mash.

In general, our post infancy bowel movements should be daily and have the consistency of a brown formed soft log (best descriptor - see image for type 4).

Warning signs of disease or problems:

1) Blood in stool. If it is bright red and associated with rectal pain, you are likely dealing with constipation and a rectal fissure. Treat accordingly. If it is large volumes of red or dark blood, seek medical attention immediately as this is never normal!

2) Mucous in stool. Often related to a viral upper respiratory infection and swallowed mucous. If the mucous is associated with diarrhea, blood, fever and malaise, seek medical help as this could be a sign of infection or inflammatory bowel disease.

3) Acute change in bowel pattern toward persistent diarrhea. You will need to be evaluated for infection (viral, bacterial or parasitic) or more serious diseases like inflammatory bowel disease.

4) Persistent green stools. Most likely milk protein intolerance especially if associated with recurrent ear infections, eczema and chronic runny nose symptoms. This could be a sign of other food sensitivities and should be evaluated further.

5) No bowel movement for more than 3 days. A clear sign of constipation. Try removing all dairy from your diet and increasing water and high fiber whole type foods. If stools are still hard and infrequent, you may have a condition called acquired megacolon and you will need help. Meet with your provider to come up wit ha plan to alleviate this debilitating concern.

Dr. M