Examine Your Stool

Normally, an individual is able to defecate once or twice per day without straining. The stool should neither be too hard nor too soft, and should not have a foul odor. There also should be no pus, blood, mucus or undigested food in it. A TCM physician usually notes the frequency, form and color of the stool as well as the accompanying feelings during defecation.

Nature of stool

An offensive odor of stool pertains to heat accumulation. Dry, dark-brown stool means excessive heat is present in the large intestine. Loose stools with a fishy odor pertain to excessive cold in the intestines. Extremely dry and hard stool is often seen in a deficiency of blood or body fluids. Loose bowels with shapeless stool usually are due to deficiency cold in the spleen and stomach.

Initial discharge of a hard stool and then discharge of a loose stool can be seen in dampness accumulation caused by a spleen deficiency. Alternate dry and loose stool in irregular patterns are due to disharmony between the liver and spleen. Stools with partly digested food and a rotten odor are caused by improper food intake, which leads to food retention. Individuals will also pass excessive gas. Stools containing completely undigested food are due to kidney yang exhaustion. Stools with yellow mucus accompanied with tenesmus (rectal heaviness) means damp-heat has accumulated in the large intestine. Pus and bloody stools are seen in dysentery. Sour stools in children are due to food retention without proper digestion.

Improper food intake leads to food retention; individuals may also pass excessive gas.

Constipation

Constipation refers to infrequency or difficulty in defecation and may be accompanied with dry or hard stool. In TCM, this is usually due to heat accumulating in the intestines or insufficient amounts of body fluids. This leads to the intestines being unable to perform peristalsis (special movements of the intestines by which the contents are moved along the cavity). TCM categorizes the condition into four types:

		Heat type: This is caused by excessive heat consuming the body fluid making the content in the bowel unable to flow freely. Individuals defecate dry or hard stools. Other accompanying symptoms are a flushed face, low-grade fever, thirst, foul breath, abdominal fullness and abdominal distention with pain that does not go away with pressure placed on the abdomen. On examination, the tongue is red, covered by a yellow dry fur; the pulse is rapid.

Cold type: Individuals have difficulty in defecation with dry or normal stool texture. Other symptoms include abdominal distention with pain that does not go away with pressure placed on the abdomen, a pale complexion, cold limbs, an aversion to cold temperatures and a preference to drink hot beverages. On examination the tongue is pale, and the pulse is deep and slow. This is a pattern of cold evil invasion that results in depression of the yang qi and obstruction of the bowel's qi.

		Qi type: The individual presents with constipation or difficulty in defecation even though he or she has an urge. The usual associated symptoms are fullness in the chest and rib sides, frequent belching and a poor appetite. On examination, the tongue is covered by thin and greasy fur; the pulse is taut.

Deficiency type: Individuals have an urge to defecate but it is difficult, and, many persons will try forceful straining to release the stool. In some cases, extremely dry hard stools like sheep feces are discharged. Other usual symptoms are a pale complexion, dizziness and fatigue. On examination, the tongue is pale; the pulse is fine and hesitant. This is a pattern of insufficiency of the blood and body fluids, or, it is due to deficiency of both qi and yin. It is often seen in chronic disease states, in the elderly and women who have just given birth.

Diarrhea

Diarrhea means frequent defecation with loose or watery stools. TCM believes this symptom is mainly caused by an attack of exogenous evils, improper diet or yang deficiency in both the spleen and kidneys, which make water descend and cause dysfunction in the intestines. TCM divides the condition into the following six types:

Damp cold type: Individuals present with diarrhea characterized by loose and watery stools. The stools are pale yellow and have a foul odor. Other accompanying symptoms are a bland taste in the mouth, fullness in the epigastric (the upper middle region of the abdomen), abdominal pain, intestinal rumblings and a poor appetite. There may be alternating chills and fever accompanied by headache, nasal congestion and general soreness. On examination, the tongue is covered by thick white fur; the pulse is slow and hesitant.

	Damp heat type: Individuals usually start with abdominal pain followed by diarrhea, and pass formless and foul odor stools with great frequency. Other symptoms include intestinal rumblings, restlessness, thirst and a burning sensation in the anus. On examination, the tongue is red and covered by yellow, thick and greasy fur; the pulse is rapid.		The tongue is red and coverd by yellow greasy fur.

	Food retention type: Individuals have foul smelling diarrhea with sour and rotten vomit, fullness of the epigastric region, intestinal rumblings, abdominal pain that is diminished after fecal discharge, a poor appetite and fever. On examination, the tongue fur is thick and greasy; the pulse is rolling. This is often due to eating unhygienic food or an improper diet.

	Spleen yang deficiency type: Individuals have diarrhea or may just pass loose and soft stool. There is undigested food in the stool. Other symptoms include poor appetite, increased stooling frequency after eating greasy foods, abdominal distention, a dull pain above the navel, a sallow complexion, fatigue and general weakness. On examination, the tongue is pale, enlarged and covered by white fur; the pulse is weak.		Poor appetite and abdominal discomfort are associated with a spleen disorder.

	Hyperactive liver qi attacking the spleen type : Individuals have abdominal pain and diarrhea following emotional disturbances. The abdominal discomfort will slightly diminish after defecation. Accompanying symptoms include fullness in the chest and rib sides, belching, loss of appetite, a bitter taste in the mouth, acid regurgitation, a sallow complexion and fatigue. On examination, the tongue is pink with little fur; the pulse is taut.
	Kidney yang deficiency type: This is due to the kidney yang failing to warm the spleen. Individuals present with abdominal pain at dawn and then pass a loose stool. The abdominal pain is relieved after defecation. There is also coldness and soreness present in the lumbar area and knees. Distension in the abdominal region and aversion of coldness are typically present. On examination, the tongue is pale and enlarged; the pulse is deep and fine.

Blood in the stool

• Stool mixed with fresh blood and foul in odor is often due to an attack of heat evils in the meridians and blood vessels.
• Dysentery: Both blood and mucus are present in the stool. Other symptoms include abdominal pain, fever, tenesmus (rectal heaviness) and abdominal urgency. This is a result of damp-heat in the large intestine.
• Black, tar-liked stool is due to blood stasis, which indicates bleeding in the upper portion of the digestive system.
• Red, bloody stool indicates bleeding in the lower portion of the digestive system..
• Blood in the stool should always be evaluated by a physician as it can be a symptom of some serious medical conditions.

Fecal incontinence

This occurs when an individual is unable to control defecation and the stool is discharged out spontaneously. It pertains to yang deficiencies in the spleen and kidneys.