“Everyone poops” as the famous children’s book says, but sometimes going can be a less than pleasant and even worrisome experience. You might even find yourself asking “Dr. Google” about what’s normal and what’s not. Let’s take a look at what your number two might be trying to tell you.
Your stool is hard, and you go infrequently.
Recent research shows that about 50% of those diagnosed with celiac disease experience diarrhea. Constipation, however, is also common in those with celiac disease, either before diagnosis or when eating gluten-free. Occasional constipation is normal, but when stools become infrequent or hard to pass for several weeks, it’s time to take action.
If you’re feeling a little backed up, drinking more fluid and eating more dietary fiber can help. You’ll find fiber in fruits, vegetables, beans and gluten-free whole grains. Increase your fiber intake slowly; eating “too much too soon” can increase gas and bloat. Adequate fluid intake is important too, so drink plenty of water or other beverages to help stools pass more easily.
You’re eating gluten free but still having diarrhea.
Continuing to have diarrhea on the gluten-free diet can be a frustrating experience. Most often, unresolved symptoms are due to unintentional ingestion of gluten. Take a careful look at your diet to make sure that gluten isn’t sneaking in where you might not expect it. Consider a visit to a registered dietitian nutritionist (RDN) experienced in counseling patients with celiac disease, who may be able to help you figure out the mystery.
You can also experience celiac disease and lactose intolerance at the same time. Many with newly diagnosed celiac disease are temporarily lactose intolerant, but this usually resolves as the intestine heals. Lactose intolerance is also prevalent worldwide, affecting 60-70% of people. Without adequate lactase enzyme to break down lactose (the natural sugar found in milk), symptoms such as bloating, gas, and diarrhea can occur. If you suspect lactose is an issue for you, consider using lactose-free dairy products or dairy alternatives. Also, some dairy foods are naturally low in lactose, such as aged cheese.
Irritable Bowel Syndrome (IBS) can make going to the bathroom an unpleasant, and often urgent, experience. IBS can occur alongside celiac disease and is more common in those with celiac disease than in the general population. There are three types of IBS: IBS-D or diarrhea predominant, IBS-C or constipation predominant, or IBS-M which alternates between diarrhea and constipation. IBS can range from being quite mild to severe enough that it affects work and family life. While the causes of IBS are not entirely understood, genetics, psychosocial factors, diet, gut function and infectious/inflammatory processes all likely play a role. There are various dietary and medical therapies available to help treat IBS, including the low FODMAP diet. Discuss what options might be best for you with your medical provider or your RDN.
Small Intestinal Bacterial Overgrowth, also known as SIBO, is when excessive amounts of gut bacteria end up in the small intestine. Once thought to be rare, new research indicates SIBO has been underdiagnosed and attributed to other conditions, such as IBS. It is more common in people with celiac disease and can cause continued bathroom issues such as gas, bloating, diarrhea and constipation. SIBO is typically diagnosed via breath test and is treated with antibiotics.
Your stool smells particularly bad or is difficult to flush.
Occasional steatorrhea, or too much fat in the stool, is normal. It can be the result of a high-fat meal, eating too many nuts or drinking too much alcohol. It can also be a symptom of celiac disease. Symptoms of steatorrhea can include stools that have an oily or greasy look to them, stool that is bulky or difficult to flush or stools that have an extremely foul smell. While short-term steatorrhea isn’t usually a sign of anything serious, more chronic steatorrhea should be brought to the attention of your medical provider. Exocrine Pancreatic Insufficiency (EPI) can occur along with celiac disease and can cause steatorrhea.
Don’t ignore more severe issues.
While everyone’s bathroom experience is different, there are a few “red flag” symptoms that are never normal that you should bring to the attention of your physician. These include unintentional weight loss, new-onset symptoms after the age of 50, rectal bleeding, nighttime diarrhea and abdominal or rectal masses. You should never ignore these signs and symptoms, and you should not attempt to treat them on your own.