Firmer poop, when water/diet/fiber/exercise don't help

August 18, 2024 9:55 PM

I need my poops to be harder/easier to wipe but the obvious steps (water, fiber, exercise, diet) are not helping (cw: poop descriptions)

I was previously been on a medicine that tended to constipate me for 2 years, so I'm not sure what my norm actually is. After going off that med 4 months ago (so likely not longer adjusting to that), poop's been unsustainably messy for months.

Poop is always very loose/soft and difficult to wipe away/clean up (taking many wipes, water on TP/bidet when accessible). It ranges from loose lumps to near-diarrhea non-lumps. I already use a bidet when possible, or water+TP, so not looking for recommendations for wiping, just how to change the actual poop.

After giving my intestines two months to adjust, I started making sure I got
1. daily more than the required water intake
2. gradually ramped up to at least 30g fiber/day (usually more, but that's just the things I make sure to eat on every single day)
3. I get a lot of cardio, stretch, and weightlifting exercise (daily and weekly).
4. I avoid foods that tend to cause looser poops (e.g. fried, fatty, gluten, caffeine, etc. Googlable lists)

I've been doing all that for ~6 weeks, without much change to the poops. Have read and tried advice in previous Asks like this

I'm on various meds that could be contributing, but at fairly low doses that I cannot lower further. This is happening daily, so I don't want to take any OTC meds that aren't safe to take ongoing (are any safe to take daily?)

Any suggestions for how I can change the poops? Thanks

(YANMD, but until I can see my doctor...)

posted by anonymous to Health & Fitness (19 answers total)

I find that hard cheeses (cheddar, etc.) are binding and help with loose stools. The classic diet is BRAT: Bananas, Rice, Applesauce, Toast.

Sorry, not much of an answer.
posted by blob at 10:01 PM on August 18 [2 favorites]

Half of a 2-mg tablet of loperamide (OTC anti-diarrheal medication) every day can help, with the dosage adjusted as needed.
posted by metonym at 10:20 PM on August 18

I struggled with this for some time (a couple of years), thinking it was side effects from Chemo/immunotherapy. It didn’t get better (and in fact got worse wet incontinence), so I went to a GI doc and we found out I have a pancreatic enzyme insufficiency - so my food was not being properly digested. There are drugs for this, and things are much improved.
Tl;dr - see a GI doc and get a medical diagnosis.
posted by dbmcd at 10:29 PM on August 18 [13 favorites]

Probiotics are your friend here. Your gut biome is probably out of whack. I have the opposite problem (constipation)... or I should say, "had", since it looks like, with treatment, it's on its way out, God willing.

I can't recommend any probiotic specifically since I have the opposite problem, but L. reuteri seems to be a nice broad-spectrum cure-for-what-ails-ye. It's readily available in a variety of different (affordable) products in the US and elsewhere. I have some on order at the moment.

I would also check for SIBO (small intestinal bacterial overgrowth). If your doctor won't go along with a SIBO test or diagnosis, you can order the test yourself from different suppliers (and find a new doctor too).

Drs. Mark Pimentel and Michael Ruscio are good sources of information on SIBO and its cousin, IBS. I'm currently relying on an herbal treatment protocol recommended by Dr. Ruscio and it seems to be doing the trick, after 2+ years of worsening gut issues.

Eating a variety of plant-based foods can also be helpful to shore up HEALTHY diversity in the gut biome. Think of a color spectrum and choose at least one fruit, veggie, shroom, alga, pulse, or legume from each color per day. (Brown is a valid color and covers most pulses!)
posted by rabia.elizabeth at 10:51 PM on August 18 [1 favorite]

This is a long shot but do you know what your hormone profile is like? I recently started gender affirming HRT and it's transformed my poops. I'm down to one solid one a day for the first time in over a decade, regardless of what I eat, after tweaking fibre, probiotics etc. for years with no success. Totally unexpected, but welcome.

(Before I started HRT I had below reference range levels of my supposed natal sex hormones, and high but within reference range levels of the 'other' kind, so there was definitely something screwy going on in that domain for me.)
posted by terretu at 11:38 PM on August 18 [1 favorite]

Are you relying on dietary fibre or supplementing as well. If you’re not supplementing, adding something like psyllium husks to your diet goes a very long way.
posted by koahiatamadl at 11:39 PM on August 18 [3 favorites]

Another vote for psyllium husk. Get the loose powder, not the capsules, so that you can measure your dose exactly to suit your needs.
posted by Zumbador at 11:59 PM on August 18

Thirding psyllium husk. Two teaspoons of Metamucil twice a day before meals has helped me enormously, in a way fiber in food didn't. It's still too frequent, but the texture is incredibly improved. The Muce is amazing.
posted by mostlymartha at 12:39 AM on August 19 [2 favorites]

While I agree you should see a doctor, mine hasn't been very helpful when it comes to digestive issues. To say the least. I have dealt with various issues since harsh regimes of antibiotics for borreliosis and also anti-depressants. The situation is very much improved today because of changes in diet and exercise similar to yours.
For you, I'm thinking about the balance of soluble and insoluble fiber. Maybe adjusting this can help you? I feel it does good things for me when I remember to eat cold potatoes or not too ripe bananas.
posted by mumimor at 12:45 AM on August 19 [2 favorites]

A lot of people with chronic loose stools (including me) have found taking calcium supplements, particularly the cheaper less absorbable ones like calcium carbonate, help a lot. Calcium has a binding effect.
posted by mochi_cat at 2:39 AM on August 19 [1 favorite]

My doctor prescribed 2g/day colestipol to reduce my stomach acid and that firmed my poops up. I was initially on 3g/day but eventually got constipated on that dose, so my doctor told me to vary the dose as needed to achieve the poop consistency and frequency I wanted. Bonus: it also helps lower cholesterol.
posted by Jacqueline at 4:01 AM on August 19 [1 favorite]

I had this problem for a long time and tried many of the suggestions above. Nothing helped more than iron supplements. But don't go crazy there becauae you can overdose on iron apparently.
posted by aetg at 4:33 AM on August 19 [1 favorite]

I had this issue over the last year. It took me longer than 6 weeks to resolve but it did. I spent massive amounts of money on Coconut Cult yogurt (the regular kind, not flavored. And it’s available in stores a little cheaper than ordering it online). Since I was cutting out dairy to make sure that wasn’t the problem thus avoiding regular yogurt as a probiotic.

On my doctor’s advice I tried the low fodmap diet for a while and it is COMPLICATED (get the Monash University app, every list you find online is weird and wrong. I also met with a nutritionist who was amazingly unhelpful! Looking up everything on the app is key) but I eventually followed it quite well for a month or so once I sorted out some meals that worked with my life, and it did actually help. I didn’t really do the reintroduction right (csa season started so I just had too many vegetables and knew that it was an imbalance and not an obscure sensitivity so figured organic garden veggies weren’t going to make a problem, and they did not!).

Anyway tl;dr natural probiotics and low fodmap for a while cleared me up. It took months, I was going crazy.

Things that didn’t work were psyllium, Chinese herbs from my herbalist, cutting out dairy (I think it helped but alone it didn’t go it). I’m already gluten free and exercise every day and drink water and follow a generally low-inflammatory diet. I was also getting some acupuncture/bodywork and I don’t know if it helped or not but stress certainly isn’t helping the issue. I didn’t think I was more or less stressed than at any other time but you may also look into that.
posted by jeweled accumulation at 6:51 AM on August 19 [1 favorite]

Another vote for psyllium husk. Get the loose powder, not the capsules

Better still, get the loose and minimally processed husk. It's already in very small bits as it comes off the plant; looks like bran. I've tried the kind that's been further ground to an actual powder and that processing just isn't worth paying for as far as I can tell. All it does is make the stuff more likely to clump than disperse.

Metamucil is just powdered psyllium husk with some kind of added flavouring that I personally find pretty horrible. It works, but so does the loose husk at about quarter of the price.

The standard recommendation is to disperse a teaspoon of husk in water and drink it before it's had a chance to gel, but I find that kind of disgusting so I just sprinkle it over other stuff. It's inoffensive on a cole slaw, for example, or mixed in with cooked oatmeal. Just make sure that whatever you add it to is fairly wet to begin with so that you're never swallowing dry husk; it sticks itself together and expands massively as it absorbs water, so if dry lumps make it into your stomach you risk stopping yourself up.

I generally take a dessertspoon per day rather than a tiny teaspoon. If I were to try to get that much husk down in capsule form, not only would I need to be swallowing a lot of capsules, I'd be risking gut clogs because the capsules are dry inside.

Psyllium husk is almost all soluble fibre, so it works best when combined with sources of insoluble fibre. Cole slaw, as I mentioned above, is a good companion.

The other treatment I use if my guts have got a bit loose is 20ml of live-culture skim milk yoghurt administered anally; I can see no point in making all those excellent little critters fight their way through a GI tract obstacle course devoted to killing them off. For me, 20ml in through the out door works far better than a litre via the top-down route.
posted by flabdablet at 7:09 AM on August 19

A handful of hazelnuts a day!
posted by cotton dress sock at 7:26 AM on August 19

All no-calorie sweeteners can cause loose stools, so if you're drinking diet pop/soda or enjoying no-calorie candy, stop that for a week to see if that's been the cause.
posted by Jesse the K at 8:49 AM on August 19

Think about the acids you consume, especially in the form of coffee/decaf. For me, going off decaf in the morning made a huge world of difference.
posted by DrGail at 8:52 AM on August 19

Kimchi and sauerkraut are probiotics. If you can take a week and do a gut reset, eat a lot of kimchi, sauerkraut, plain yogurt(no added sugar, gelatin, etc. but fine to add your own fruit, maybe honey), plus kefir, fresh fermented pickles, sourdough bread. Avoid foods that are constipating. Sugar can have an effect on your gut, so cut way back on all sugars.

Then see how things rebouind. Your description sounds a bit like IBS, so a visit to a gastro doc is a good idea, because I am not a health care professional and with several medications to consider, that's who you should talk to.
posted by theora55 at 9:16 AM on August 19

You mentioned removing obvious dietary culprits, but a food diary may shed light on less-common intolerances. It’s how I figured out that I did not actually outgrow my childhood carrot allergy.
posted by tchemgrrl at 6:59 PM on August 19