Admit it ladies, there is a strange energy when it comes to women and their poop. When we have to go, we like to do it alone, out of earshot of any living person. It's as if there is a quiet, unwritten code that requires women to be poopless. We've grown up with the longstanding myth that women don't defecate; rather, they expel flower petals from their rectums. That lie, and the ensuing anxiety it creates, has lent itself to a difficulty examining our daily doo-doos or discussing them with anyone, including our doctors.
Whether women want to admit it or not, pooping is a real and (hopefully) regular part of our lives. We don't have be ashamed or pretend that we don't poop. We shouldn't be embarrassed to talk about our bowel habits and movements with our doctors, either, as the information could be vital to understanding our digestive health.
In an effort to destigmatize female defecation and get the true scoop on poop, I spoke with Dr. Catherine Ngo, a board certified gastroenterologist who trained at UC Davis Medical Center in Sacramento, Calif. and was awarded memberships into both the Alpha Omega Alpha Honor Medical Society and Arnold P. Gold Humanism in Medicine Foundation.
Dr. Ngo is currently a part of the medical team at Saddleback Memorial Medical Center in Laguna Hills, Calif., which was designated as one of America's 50 Best Hospitals by Healthgrades. Her specialty involves understanding our body's digestive tract and diseases that can arise within this complicated system. For her, poop is simply a byproduct of a functioning body and it has the ability to relay important health information to us, if we're paying attention. Here's what we asked her.
Q: Should women discuss their bowel habits with their doctors?
Dr. Catherine Ngo: Women and men alike are often too embarrassed to discuss bowel habits with their physicians; however, our bowel functions affect our daily lives and it is an important part of our quality of life. How many people have we known to have taken sick days from work or school due to abdominal symptoms? In my experience these issues come back to the bowel habits, or a lack of regularity. As a patient advocate, I always recommend that patients speak to their physicians about any quality of life issue they may have. Bowel habits are just one of many.
Q: What constitutes a healthy bowel movement?
Dr. Catherine Ngo: A healthy bowel movement varies by individual, but in general normal frequency is typically considered between twice per day to three times a week. Stool texture should be formed, soft, easy to pass without excessive straining and leaves one with a sense of complete evacuation.
Q: What basic health information does our poop tell us?
Dr. Catherine Ngo: They can give us some insight into our general health and deficiencies. For example, with texture, if your stool is too hard or dry and you are straining and bleeding, this may indicate a deficiency in hydration and/or dietary fiber. If your stool is too watery, this may indicate a malabsorption issue which can range from small bowel disorders like celiac disease to large bowel disorders like microscopic colitis.
In regard to color, if your stool is black, this may indicate blood loss from the upper digestive tract due to something like ulcers. If it is maroon or red, this may indicate blood loss from the middle or lower digestive tract due to inflammatory bowel conditions such as Crohn's disease or ulcerative colitis, bleeding conditions or tumors of the digestive tract. If it's pale or gray, this may indicate a deficiency of bile flow, suggesting a pancreas or bile duct issue that can range from obstructive gallstones to pancreatic tumors. Stool samples can also be checked for a variety of common bacterial and viral infections that can cause vague gastrointestinal symptoms.
Helicobacter pylori is a common stomach infection that can cause indigestion and ulcers. It can be detected in a stool test so that effective treatment can begin. This is important to check for because in certain cases, patients can go on to develop a type of lymphoma of the stomach that began with this infection.
Q: When should women be concerned about their bowel movements?
Dr. Catherine Ngo: Any noticeable change in bowel habits that persists for more than a couple of weeks should be discussed with your doctor. Symptoms that are typically considered red flags are if they are accompanied by any new abdominal discomfort, blood in stool (black, maroon, or red), significant change in coloration of stool (pale gray), loss of appetite, fevers, night sweats, lack of bowel movements in a week, and/or any significant unintentional weight loss.
It is hard to characterize concerns in terms of chronic diarrhea or frequency, because it truly depends on the individual's baseline bowel habit. It's more accurate to assess if there has been a change in those bowel habits. For example, one individual may have two to three loose stools per day and another may typically have one hard bowel movement per week, which may be completely normal for them.
Q: Are there any concerns specific to women in relation to gut health and bowel movements of which they should be aware?
Dr. Catherine Ngo: Interesting fact—on average, women's colons are up to 30 percent or 10 centimeters longer than their male counterparts. Knowing this, it is easy to understand why women tend to have a disproportionate number of digestive issues and concerns, typically encompassing constipation, bloating and gas, discomfort or difficulty with elimination, and often a sense of incomplete evacuation.
While men's colons typically resemble a horseshoe (upside down U shape), women's colons often have to compete with their internal reproductive organs (uterus, tubes and ovaries) for space, resulting in a more twisted and redundant configuration. This is typically the reason for many of the digestive complaints my patients have.