By JULIE MATEL, RD, Stanford University CF Care Centre
Much to the chagrin and embarrassment of CF patients everywhere, bowel movements are an important part of our lives. In many ways our bowel movements serve as a benchmark that lets us know how things are going, so to speak, with our digestive systems. Cystic fibrosis patients with pancreatic insufficiency should be especially aware of all things related to their digestive process, and be able to identify what’s normal for them and what isn’t.
When the pancreas is too blocked by mucus, it can’t deliver the enzymes necessary to break down the foods we eat, particularly proteins and fats. As a result, people with CF may have more frequent bowel movements because they are not absorbing the protein and fat that they are eating. As if that weren’t embarrassing enough, CF patients are also prone to flatulence (gas). Their gas and BMs can be particularly foul-smelling as the result of proteins and fats not being absorbed by the body.
So how can a person with CF determine what’s a normal BM and what isn’t? Consider these three factors:
Brown is generally the “preferred” color of healthy stool, though there may be different variations on that theme.
The liver excretes bile salts into the stool, giving it a normal brown color. Obstruction to the flow of bile out of the liver (you may see the word “cholestasis”), or liver infections like viral hepatitis, may produce clay-colored stools .
Black, tarry stools with a foul odor can be the result of eating certain foods, taking iron supplements, or possibly from internal bleeding. Foods that are dark blue or black in color may also cause black stools. Examples of foods and minerals causing dark stools include: black licorice, blueberries, iron supplements, lead, Pepto Bismol (contains bismuth.)
Green , leafy vegetables contain chlorophyll which could be coloring the stool green . Another possibility is that the stool has passed too quickly through the large intestine and has not yet had all of the bile absorbed. Sometimes newborns have green colored stools, and this is perfectly normal.
Patients with cystic fibrosis often have gall bladder issues, which can cause the stools to appear orange. This is because bile, which normally helps process fats in foods may not be excreted adequately. Stools are usually orange if they contain a lot of oil and fat that the bile salts have not had enough time to break down. A lack of bile (because of bile blockage such as gall stones) can also cause stools to appear orange. Orange, greasy stools are particularly foul-smelling, and may be difficult to control.
Healthy stools should be uniform in shape and consistency. They should sink and not float. Floating stool is evidence that you are not absorbing enough fat from your food.
Loose, watery stools may indicate a stomach virus, especially if they are concurrent with vomiting. In young children especially, it’s important not to let diarrhea lead to dehydration. Dehydration as a result of lost water through the stools may also contribute to intestinal blockage. If the small intestine, which usually adds water to digested food, is unable to do so, the fecalization process cannot take place and the stool can back up into the upper gastrointestinal system.
Stools that are difficult and painful to pass are often the result of not enough fiber in the diet. Patients with cystic fibrosis have to strike a delicate balance between having just enough BMs to prevent bowel obstruction, but not so many that they lose water and vital nutrients.
Cystic fibrosis patients are encouraged to eat several small meals throughout the day instead of 3 large ones, as a way to avoid painful bloating and stomach pains. This means that for some people, going to the bathroom 6 times a day is just part of life. Some patients with cystic fibrosis are very regular in their bathroom habits, and can accurately predict which foods will go through more quickly than others. Usually it’s the foods that are high in fat content that cause a person to use toilet shortly after eating.
One of the earliest signs of cystic fibrosis is a condition called meconium ileus. Approximately 20% of cystic fibrosis will be diagnosed at birth because of mecomium ileus. Meconium is the material present in the intestines of a newborn. In meconium ileus, intestinal obstruction results from the impaction of thick, tenacious meconium in the small bowel.