Changes in stool (feces) color are often harmless and reflect dietary influences. The normal brown color of stool occurs due to the presence of bilirubin. Bilirubin is formed as a breakdown product of hemoglobin (from red blood cells) in the liver and is secreted into the bile, which enters the intestines. If the intestinal contents travel at a normal speed, chemical changes in bilirubin produce stool that is light to dark brown. The stool may appear green if the intestinal contents pass through the bowel more rapidly.
Changes in the color of stool are common and are generally not significant if the changes are noted from one stool to the next and are not persistent. However, changes in the color of stool can also be caused by a number of minor to serious medical conditions and can occur with certain medications. Changes in stool color that are persistent and do not occur in only one stool may signal the presence of a medical condition and should be evaluated.
Certain persistent changes in stool color are characteristic for specific conditions:
- black, foul-smelling stool: intestinal bleeding (typically from the stomach and upper small intestine) due to ulcers, tumors; ingestion of iron or bismuth
- maroon stool: intestinal bleeding (from the middle intestine or proximal colon) due to ulcers, tumors, Crohn's disease, ulcerative colitis
- clay-colored stool: lack of bile due to blockage of the main bile duct
- pale yellow, greasy, foul-smelling stool: malabsorption of fat due to pancreatic insufficiency, as seen with pancreatitis, pancreatic cancer, cystic fibrosis, celiac disease
Other causes of stool color & texture changes
- Barium (From a Radiographic Test)
- Bile Duct Cancer
- Bismuth-Containing Medicines (for Example, Bismuth Subsalicylate [Pepto-Bismol])
- Bleeding Into the Intestines
- Bleeding Into the Stomach or Esophagus
- Consumption of Black Licorice
- Consumption of Certain Fruits and/or Vegetables (for Example, Beets, Spinach, and Cranberries)
- Food Dyes (Particularly Red and Green)
- Infectious Colitis
- Intestinal Malabsorption
- Iron Supplements
- Tumors of the Pancreas or Pancreatic Duct
- Tumors or Polyps of the Stomach or Intestines
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.Next Article
Main Article on Stool Color & Texture Changes
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Causes of Stool Color & Texture Changes
H. pylori (Helicobacter Pylori) Infection
Helicobacter pylori (H. pylori) is a bacteria that causes chronic inflammation (gastritis) of the inner lining of the stomach, and also is the most common cause of ulcers worldwide. About 50% of people in the world carries or is infected with H. pylori. Common symptoms of H. pylori infection are occasional abdominal discomfort, bloating, belching or burping, and nausea and vomiting. H. pylori infection is difficult to eradicate, and treatment is with two or more antibiotics.
Acute & Chronic Pancreatitis: Symptoms, Causes, Diet, and Treatment
Pancreatitis is a rare disease in which the pancreas becomes inflamed. There are two types of pancreatitis: acute and chronic. Symptoms of pancreatitis include abdominal pain, fever, nausea, vomiting, and a rapid pulse. Treatment of pancreatitis often requires hospitalization.
Anal cancer, cancer located at the end of the large intestine, has symptoms that include anal or rectal bleeding, anal pain or pressure, anal discharge or itching, a change in bowel movements, and/or a lump in the anal region. Treatment for anal cancer may involve radiation, chemotherapy, or surgery and depends upon the stage of the cancer, its location, whether cancer is eradicated after the first treatment, and whether the patient has HIV.
An anal fissure is a small tear or cut in the skin lining of the anus. Pain and/or rectal bleeding during bowel movements are common symptoms of anal fissures. Treatment includes increasing liquid intake, using stool softeners, prescription medications, and surgery.
Blood in the Stool (Rectal Bleeding, Hematochezia)
Blood in the stool or rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Common causes include anal fissures, hemorrhoids, diverticulitis, colitis, Crohn's disease, colon and rectum polyps, and cancer. The color of the blood in the stool may provide information about the origin of the bleeding. The color of stool with blood in it may range from black, red, maroon, green yellow, gray, or white, and may be tarry, or sticky. Treatment of blood in the stool depends on the cause.
Celiac disease is a condition in which a person has inflammation of the small intestinal mucosa when exposed to gluten in the diet. Symptoms of celiac disease include bloating, nausea, diarrhea, and abdominal discomfort. Treatment is a gluten free diet. Some individuals may have refractory celiac disease in which they do not respond to a gluten free diet.
Cholera is an infectious disease characterized by intense vomiting and profuse watery diarrhea and that rapidly lease to dehydration and often death. Cholera is caused by infection with the bacteria Vibrio cholerae, which may be transmitted via infected fecal matter, food, or water.
Crohn's disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are common symptoms.
Crohn's Disease vs. Ulcerative Colitis (UC)
Crohn's disease and ulcerative colitis are diseases that cause inflammation of part of or the entire digestive tract (GI). Crohn's affects the entire GI tract (from the mouth to the anus), while ulcerative colitis or UC only affects the large and small intestine and ilium. Researchers do not know the exact cause of either disease. About 20% of people with Crohn's disease also have a family member with the disease. Researchers believe that certain factors may play a role in causing UC. Both Crohn's disease and ulcerative colitis are a type of inflammatory bowel disease, or IBD. Crohn's disease and ulcerative colitis both have similar symptoms and signs, for example, nausea, loss of appetite, fatigue, weight loss, episodic and/or persistent diarrhea, fever, abdominal pain and cramping, rectal bleeding, bloody stools, joint pain and soreness, eye redness, or pain. Symptoms unique to Crohn’s disease include anemia and skin changes. Symptoms of unique to ulcerative colitis include, certain rashes, an urgency to defecate (have a bowel movement). Doctors diagnose both diseases with similar tests and procedures. While there is no cure for either disease, doctors and other health care professionals can help you treat disease flares, and manage your Crohn's or UC with medication, diet, nutritional supplements, and/or surgery.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, with bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
E. coli (0157:H7) Infection
There are many types of E. coli (Escherichia coli). E. coli can cause urinary tract and bladder infections, or lead to sepsis. E coli O157:H7 (EHEC) causes bloody diarrhea and colitis. Complications of E. coli infection include hemorrhagic diarrhea, hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura. Symptoms include severe abdominal pain and bloody diarrhea. E coli O157:H7 commonly is due to eating raw or undercooked hamburger or raw milk or dairy products.
Exocrine Pancreatic Insufficiency (EPI)
Exocrine pancreatic insufficiency or EPI is a condition in which a person's pancreas can't produce or secrete certain enzymes into the gastrointestinal tract, which results in the inability to digest and absorb some minerals, vitamins, and fats from food. Symptoms of EPI include diarrhea, bloating, excessive gas, bone pain, and foul smelling bowel movements. Treatment for EPI is PERT therapy.
Gallbladder cancer is a rare form of cancer with symptoms that include jaundice, abdominal pain, fever, nausea and vomiting, abdominal lumps, and bloating. Risk factors include being female and Native American. Treatment of gallbladder cancer depends upon the stage of the cancer, the type of gallbladder cancer, and whether the cancer can be removed by surgery.
Gastritis Symptoms, Causes, Diet, Home Remedies, Treatment, and Cure
Gastritis (acute and chronic) is an inflammation of the lining of the stomach Some people have no gastritis symptoms, but when they do occur they may include bloating, belching, loss of appetite, nausea, and vomiting. H. pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) are the two main causes of gastritis. Alcohol, caffeine, and high-fat foods also can cause gastritis. Fried, fatty, and spicy foods, and alcohol aggravate gastritis symptoms. Other stomach lining irritants that aggravate symptoms include cigarette smoking, acidic juices, caffeine, tomato products, peppers, and chili powder. Foods that sooth gastritis symptoms, and that help reduce and stop H. pylori infection growth in the stomach include apples, onions, garlic, teas, green leafy vegetables, coconut water, and wheat bran. Gastritis is diagnosed with endoscopy, blood tests, or stool tests. Some people get relief from gastritis symptoms with prescription and non-prescription antacids, histamine blockers like famotidine (Pepcid AC) or ranitidine (Zantac 75), or proton pump inhibitors (PPIs) like omeprazole (Prilosec) and esomeprazole (Nexium). These drugs will not cure gastritis. Complications of gastritis include gastric cancers, MALT lymphoma, renal problems, and death.
Hepatitis (Viral Hepatitis, A, B, C, D, E, G)
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Hepatitis B (HBV, Hep B)
The hepatitis B virus (HBV, hep B) is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Hepatitis C (HCV, Hep C)
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by blood transfusion, hemodialysis, and needle sticks, especially with intravenous drug abuse. Symptoms of chronic hepatitis include fatigue, fever, muscle aches, loss of appetite, and fever. Chronic hepatitis C may be cured in most individuals with drugs that target specific genomes of hepatitis C.
Hepatitis E Viral Infection
Hepatitis E (hep E) is a type of hepatitis viral infection that includes hepatitis A, B, C, D, F, which is caused by the hepatitis E virus. Usually, you get (transmitted) hepatitis E from eating or drinking dirty or contaminated water. Hepatitis E can be very serious, especially if a woman is pregnant. Up to ¼ of women who are pregnant with the hep E virus can die from the infection. The signs and symptoms of hepatitis E infection are nausea and vomiting, brown or dark urine, stool changes jaundice (yellow eyes and skin), pain in the right side of the abdomen, dark or brown urine, and light-colored stool. Some people with hep E don’t have any symptoms so they don’t know that they are contagious. It takes about 6 weeks to recover from hep E. A person who has any type of hepatitis, including hepatitis E, should not drink any alcohol. Hep E complications are rare, but when they do occur they include severe (“fulminant”) hepatitis, liver failure, and death. Currently, no specific drugs or treatments are available for hepatitis E. Moreover, the only hepatitis E vaccine currently is available in China. Avoid alcohol, keep hydrated, and getting rest are home remedies for hepatitis E. Talk to your doctor before taking any over-the-counter (medications), especially those containing acetaminophen (Tylenol and others). Usually, the prognosis and life expectancy for hepatitis E after recovery is good. Most people do not have long term liver problems from the infection.
Inflammatory Bowel Disease (Intestinal Problems of IBD)
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Is C. diff (Clostridium difficile) Contagious?
C. diff, or Clostridium difficile, is a bacteria that infects the colon. C. diff bacteria can be found on furniture, bathroom floors, telephones, fingernails, jewelry, toilet seats, and other places.Symptoms of C. diff infection are fever, abdominal pain, and cramps; however, not all people infected with C. diff have symptoms. Treatments for C. diff are antibiotics and surgery in some cases.
Is Colitis Contagious?
Colitis is a term that us used to describe inflammation of the colon. The terms enteritis, proctitis, and inflammatory bowel disease (IBD) now include colitis. Colitis has many different causes. Some types of colitis are contagious and some are not contagious. Symptoms of colitis include diarrhea, abdominal discomfort, cramping, pain, and blood in the stools. Treatment for colitis depends on the cause and type of colitis.
Is Hepatitis A Contagious?
Hepatitis means inflammation of the liver. Hepatitis A is one type of hepatitis. Hepatitis is transmitted through person to person contact, contaminated ice, vegetables, fruits, and untreated water. Hepatitis A can be prevented by the hepatitis A vaccine. Symptoms of hepatitis A may include nausea and/or vomiting, fever, loss of appetite, abdominal pain, dark urine, clay-colored stools, jaundice (yellowish color to skin and/or eyes, or joint pain.
Jaundice (Hyperbilirubinemia) in Adults
Jaundice (hyperbilirubinemia) in adults may be caused by a variety of medical diseases or conditions. Some cases of jaundice can be managed at home with a doctor's supervision, while other causes of jaundice may be life-threatening. Symptoms of jaundice are yellow skin, yellowing of the whites of the eyes, pale colored stools, dark urine, itchy skin, vomiting, nausea, and rectal bleeding. Treatment of jaundice is focused on the disease or condition that is causing jaundice.
Lactose intolerance is a common problem where a person's digestive system cannot digest lactose. Signs and symptoms include: Diarrhea Gas Abdominal pain Abdominal bloating Abdominal distention (swelling) Nausea There are several tests to diagnose lactose intolerance. Treatment is generally made with dietary changes, supplements, and adaptation to small amounts of milk.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause early symptoms. Typically, pancreatic cancer has metastasized (spread to adjacent organs, such as the liver) by the time most people receive a dignosis of pancreatic cancer. Symptoms and signs usually appear later in the course of the disease and include jaundice, back pain, nausea, weight loss, itching, and loss of appetite. Treatment depends upon the type of pancreatic cancer but may include surgery, chemotherapy, and/or radiation therapy.
Peptic Ulcer (Stomach Ulcer)
Peptic or stomach ulcers are ulcers are an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to H. pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking. Symptoms of peptic or stomach ulcers include abdominal burning or hunger pain, indigestion, and abdominal discomfort after meals. Treatment for stomach ulcers depends upon the cause.
Salmonella infection (salmonellosis) is typically caused by the consumption of contaminated foods. Symptoms of salmonellosis include fever, vomiting, diarrhea, and abdominal pain. Salmonellosis typically resolves on its own in four to seven days. It's important to increase one's fluid intake to compensate for the fluid lost by vomiting and/or diarrhea.
Shigellosis is a disease caused by the Shigella bacteria. Bloody diarrhea, stomach cramps, and fever are common symptoms. Mild infections usually resolve on their own. Antibiotics are used to treat more severe cases.
SIBO (Small Intestinal Bacterial Overgrowth)
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine, but they are more like the bacteria that are found in the colon. There are many conditions associated with SIBO, including: Diabetes Scleroderma Crohn's disease Irritable bowel syndrome (IBS) It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: Excess gas Abdominal bloating Abdominal pain Treatment for SIBO can include: Antibiotics Probiotics Low FODMAP Diet
Though the cause of stomach cancer is unknown, risk factors for stomach cancer include diet, H. pylori infection, smoking age, gastritis, stomach surgery, family history, and pernicious anemia. Symptoms include stomach discomfort, feeling full after a small meal, nausea and vomiting, and weight loss. Treatment depends upon staging and may involve surgery, radiation therapy, or chemotherapy.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
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