How to go to the doctor for poop issues?
July 31, 2017 5:58 PM   Subscribe

Over the past year or two, my bowel movements have changed. While I doubt anything is seriously wrong, I'm a BIG fan of medical peace of mind, so I'd like to talk to a doctor. But I've never gone to the doctor for this kind of thing before, so I'm looking for advice about exactly how to approach it.

More details about me and my symptoms: I'm 37, female, of average height/weight and generally in excellent health. I just had a full physical in May, including pelvic exam and multiple blood tests, and everything came back looking great. I'm an omnivore who generally eats pretty well; I'd estimate 75% of my diet is "good" stuff (whole grains, fruits, veggies, lean meats, eggs, peanut butter, beans, etc.) and 25% is less than ideal, but nothing crazy (refined grains and sugar, pizza, cheese, some occasional red meat or fried food). For most of my adult life, my bowel movements were very regular: once a day or every other day, and a 2 or 3 on the Bristol stool chart. In the past year or two, my bowel movements have become much looser -- not to the point of watery diarrhea, but it's either a big mushy pile, or a long, thin snake that will kind of explode as soon as I flush the toilet. The consistency is so weird -- it looks like someone took, like, carrot cake batter and formed it into a long snake. (Not that it's orange, although it tends to be lighter in colors than it used to be.) I think there's also a good deal of undigested food in there, and sometimes I get those oil slicks on top of the water. I don't feel any pain or cramping; its just the consistency that's different.

My main health problem is anxiety and panic, which can often cause me to have a nervous stomach. I had a TERRIBLE time with anxiety in 2016, so I chalked up my bowel issues to that. But now I'm doing a lot better but still having this weird poop consistency, so I'd like to talk to a doctor about it.

Here are my specific questions about doing to the doctor:

1. Should I go see my nurse practitioner about this, or a specialist? What kind of specialist would it be? (Internist, gastroenterologist, nutritionist?)

2. Would it be helpful to log a few weeks of "data" before I go to the doctor? (For example, I could write down everything I eat, the time of my bowel movements, and a description of the consistency.)

3. Would the doctor want to see a stool sample, and if so, how does this work? I am almost positive that I can't poop on command. Would they ask for it after the appointment, or do I need to pick up some kind of lab container before the appointment?

4. Besides my diet, current anxiety status, and poop consistency, can you think of other relevant information I should be sharing with the doctor?

[As an aside: this is my very first AskMefi question and I'm kind of proud of myself that I beat my Midwestern roots into submission and let it be about something so personal and quasi-disgusting.]
posted by leftover_scrabble_rack to Health & Fitness (14 answers total) 4 users marked this as a favorite
I would think that your nurse practitioner, especially if you've dealt with him/her before and he/she is part of a medical practice, would be a good place to start. But don't let him/her pooh-pooh your concerns. (Sorry, I couldn't resist.) At least press for an explanation of why it shouldn't be a source of concern, if that's his/her conclusion. And if you need to see a specialist, your nurse practitioner should be able to point you in the right direction.

In whatever time you have before the appointment, it would probably be a good idea to collect the sort of data you suggested. If for no other reason than to strengthen your resolve and expand your knowledge. You might also want to think about what was coincident with the noticed change a few years ago. But I wouldn't delay making the appointment, just in case. Seemingly minor changes can turn out to be very significant. Ask me how I know.
posted by DrGail at 6:28 PM on July 31

1) I would check with either your GP and/or a gastroenterologist. Please also don't rule out something like Endometriosis.

A GP is kinda like your hub. Specialists are really that, specialized. They often don't think outside their box. So a GP can help you put it all together. Though I think you could book both appointments instead of seeing a GP first.

2) Yes, track your food and your bowel. There's an iPhone app called Cara which is exactly for this. (Not on android yet.)

3) Your doctor may want a stool sample. If so, they will tell you how. You'd likely get some sort of container that you take home. I know when I've done stool samples you catch the stool and scrape some of it then put that in a baggie. But it depends. They'll either give you a kit or send you to a lab to get a kit. Then you generally drop off your sample at the lab or at the doctor's office at your leisure. (This may change, depending on your doctor/test but they will tell you.)

4) Relevant information would be medications, any other symptoms, menstrual cycles.

Hi! Queen of stomach problems here including GERD and IBS. Done all the tests. Also have POTS and Endometriosis. Had gallbladder surgery 2 years ago. Had endo surgery 2 months ago. Feel free to message me.
posted by Crystalinne at 6:30 PM on July 31

Start with your GP (or nurse practitioner). He/she will probably order a fecal blood test. It's an multi layer envelope with sealable tabs that you smear poop samples onto at home and then mail in for examination. All you do is lay down a few sheets of toilet paper in the bowl before pooping and that floats it long enough to stick one of the supplied popsicle sticks into it for a sample. Not a big deal.
posted by bonobothegreat at 6:31 PM on July 31

I'm not in the US so medical practices may vary considerably. But when I started having digestive issues last year, I started with my GP. She suggested I keep a log and printed out a paper form; I subsequently researched and found an app called mySymptoms which lets you track lots of variables - as many or as few as you want, including options for diet, bowel movements, sleep, medications, stress and other environmental factors. There's a lite version which is free, most of the reporting functionality requires you to pay but either way it's a useful tool.

So I would suggest 1 - GP; 2 - yes; 3 - not ahead of time and I would be surprised if they expected you to poop on command, they'll talk to you about how to do it and give you an appropriate container; 4 - also medications, menstrual cycle, sleep.
posted by Athanassiel at 6:32 PM on July 31 [1 favorite]

So I'm just a bit older than you and started having digestive issues around your age. As I said to my Primary Care doc at my last appointment, "I never thought that reaching 40 meant I'd be talking about my poop so much."

I've been in to see my primary care physician about my poop issues a handful of times over the last 3-4 years beyond my annual physical. I'd start with a regular doctor/NP and they can refer you up the chain depending on what's going on. I underwent a flurry of tests and we basically ruled out anything like cancer (though I decided to forgo the colonoscopy for now, which was essentially the last test left) and gluten issues. Working diagnosis: hormonal changes and IBS. I'm basically managing it with a far less adventurous diet than I had 5 years ago, a good probiotic, alternating Miralax and Immodium as needed, and being more attentive to hydration.

What was helpful in my first real discussion with my doctor about this:
1) Overcoming any lingering embarrassment and, yes, giving her detailed descriptions of my poops (or lack thereof)
2) Bringing in a list of a month or two where I'd tracked my bowel difficulties
3) Starting a list of foods I could correlate to unfortunate events (goodbye, most legumes, onions, and cauliflower)

Wait for the doc to suggest a stool sample (and then yes, you'd be given a container); mine never did, but we went straight to various imaging tests....
Good luck, and don't be afaid to see your doc!
I feel like answering a poop questions is also a kind of MeFi rite of passage, woohoo!
posted by TwoStride at 6:34 PM on July 31

Definitely visit your nurse practitioner first. Your NP can help do the detective work about what the issue might be, and you may need a referral from the NP before going to a specialist.

Other info to share that could be relevant:
- Your menstrual cycle and what its patterns are usually like
- Any medications or supplements you're taking (including vitamins, fish oil pills, etc.)
- Any family history of GI issues or diabetes

I know someone who had a similar-sounding problem. He got a stool test, and the results were fine except for very low counts of normally present bacteria. He took a prescribed probiotic for a while and the problem cleared up. Here's hoping that your problem is just as small and easily solved.

Congrats on taking charge and tackling this head-on! Memail me if you want any pep talk before or after your visit!
posted by cadge at 7:53 PM on July 31

Hi, l_s_r. When I noticed something similar to what you describe, I remembered the seven warning signs of cancer, and the first item on the list, which is " Change in bowel or bladder habits." Subsequently, I noticed a small amount of blood in the stool. Turns out I did NOT have cancer--but I did have ulcerative colitis , which is now under control thanks to my very skilled gastroenterologist. So, seconding everyone above. Your GP will probably start with a stool sample. If there's anything unusual, he/she will no doubt refer you to a gastroenterologist (often specialists are booked up, so you might have to wait a month or so to get in to see one). My gastroenterologist always asks me about my poop--it can be a good indication of bowel health. Yeah, it's weird to talk about, but they're doctors, they study everything. Good that you noticed something, and good that you asked about it.
posted by apartment dweller at 8:12 PM on July 31

I dealt with something similar. My primary referred me to a gastroenterologist. Gastroenterologist diagnosed mild Irritable Bowel Syndrome and prescribed metamucil once a day. Said this complaint is very, very common particularly amongst women our age. And, actually, with the fear gone, my anxiety about the symptoms has abated and they're now virtually non-existent.

Best of luck.
posted by TryTheTilapia at 6:48 AM on August 1

I had a TERRIBLE time with anxiety in 2016, so I chalked up my bowel issues to that.

Did you start taking any prescribed anti-anxiety meds for that? Almost anything that affects brain function will also affect your gut in some fashion.

Certainly worth raising this with your doctor and asking for a faecal occult blood test to rule out various potentially nasty kinds of gut disease. These come as a kit with comprehensive written instructions. Sample collection is easy and generally done over two days at home, then you mail the kit back to the lab for the actual test.

If the test shows nothing abnormal, the next step would be tweaking your internal ecology to persuade it to settle into a new stable pattern that's less messy. Useful tools for this are soluble fibre such as psyllium husk, which can physically glue a wet mush together into a cohesive mass that slips along easily without sticking to the sides, and assorted kinds of live culture.

I've had good results both from full-fat plain yoghurt (in quite large quantities because everything north of the colon is a really harsh environment for dietary bacteria, so their survival rate's not very high) and from probiotic supplements that come in in enteric coated capsules that get the contents delivered where they need to go. Flavoured yoghurts are usually super high in added sugar, so I avoid those; treating them as any kind of staple would probably do me more harm than good.

Keeping comprehensive notes is an excellent idea, both before and after seeking medical attention.
posted by flabdablet at 6:52 AM on August 1

I'm a GI albeit not yours ;)

You have written a very clear description, I recommend you print it out and bring it to your doctor/NP. Other relevant information to include might be

- any visible blood in stool ever Y/N
- any dietary changes around the time your bowel movements changed
- any dietary triggers
- nocturnal diarrhea Y/N
- weight fluctuations
- any recent-ish antibiotics, any medications including OTCs/herbals/supplements
- any "stomach flu"-like symptoms around the time when the bowel habits changed
- any GI diseases in the family
- any other symptoms like joint pain, conjunctivits, anything
- your activity level/ are you a runner Y/N, change in activity level
- any change in lifestyle around the time bowel habits changed

Hope this helps. Doctors and nurses discuss this stuff all the time including at lunch, so don't worry about being too explicit. Sometimes we even look at pictures of peoples' stool samples on their phones. Not all of us do but I personally don't mind so you might have one stored just in case ;)
posted by M. at 7:13 AM on August 1 [2 favorites]

I can only offer advice on giving a stool sample (which I had to do last year). They asked if I thought I could poop in the office and I just told them no as there was basically no chance that was going to happen. :) They gave me a little plastic container and I collected the sample at home, and then brought it back. It was kind of gross carrying around poop in my bag!!! But otherwise very easy.
posted by rainbowbrite at 8:02 AM on August 1

Track it with your menstrual cycle. I got that soft snake texture like you describe at one point during my pregnancy, it was like that spray foam caulking stuff that goes around windows. Gross! I chalked it up to hormonal changes.
posted by WeekendJen at 1:35 PM on August 1

Thanks for the great advice, everyone! Since last night, I made an appointment with my NP for August 21, and downloaded/started using the Cara app so I'll have about 3 weeks worth of data to share with her. And flabdablet, I *did* start taking Lexapro for anxiety last fall, so maybe that's part of the issue right there.
posted by leftover_scrabble_rack at 2:46 PM on August 1

Update for those with a similar question: I did indeed see my nurse practitioner last week, who is 100% convinced that there's nothing serious going on. She said that if I had cancer or another serious condition, I would have blood in the stool, severe pain, fevers, etc. She said it's most likely a food issue; she recommended tracking my fiber intake or experimenting with removing "problem" food groups like wheat or dairy. No stool sample required, and I'm relieved to have a medical professional assuage my fears!
posted by leftover_scrabble_rack at 8:43 PM on August 31

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