# The flat stool question.... What's the definition?



## Brocksterdanza (Dec 2, 2013)

Good afternoon everyone. I was hoping that someone can maybe answer a couple questions for me. I have very severe anxiety and I'm terrified of going to the doctor. I have recently been noticing my stool is coming out semi flat. I've looked on the Internet as many people have and can't grasp what a flat stool exactly looks like. However no one really gives a definitive answer. I'm a teacher and can honestly say this is my only bad habit. Im a bit of a worrier. My stools for the most part are semi round (cylindrical much like the shape of a jelly bean except larger scale). They are not perfectly circular like what we want. I sometimes have small pieces, etc but all are around the same girth. I now know I do not get enough fiber each day (see now that 25-30 grams are optimal) I get about 15. Is it possible that with me having a fiber deficit that my stool is softer thus not able to be perfectly round? I do not have other symptoms, ie, blood, weight loss, fatige etc, but like for things to be normal. And to be quite honest, I am unsure how long they have been this way, I've just recently ( last month or so) started looking. If I had flat stool, would it be like an airhead candy or like a pencil? As said, it is more semi ovular with normal width. Good color etc. please help with any info. Thanks


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## Kathleen M. (Nov 16, 1999)

I would see if extra fiber in the diet bulks things up a bit and allows the stool to hold it's shape better. Generally slightly too soft (so maybe a bit more deformable) is prefered over too hard (and it will hold its shape but may be on the dry side and hard to pass)..

As it gets harder and drier and you have to strain more to pass it you can risk hemorrhoids developing or getting worse.

I don't think there is some medical definition of flat where you know something is bad. Soft enough stool can come out all kinds of odd deformed shapes (or broken into odd shaped pieces).

I understand the less than perfect generates worry, but really it isn't a big medical issue if your stool is somewhat less than perfect on a regular basis.


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## Brocksterdanza (Dec 2, 2013)

Thanks for the reply Kathleen. I just look and see it and see that it doesn't look like the perfect picture and think something is wrong. Are you saying this could be my normal type? My stool comes out easy and I rarely have to strain. Most of the time it's like the level 5 on the bristol chart.... Just not circular.. Hasn't the flat stool means cancer myth been debunked by doctors now?


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## Kathleen M. (Nov 16, 1999)

Yes, and usually it is pencil thin, not just anything not quite round.

There was a paper awhile ago that showed that most less than perfectly round stools (thin, flat, etc) is when the stool is on the soft side and just doesn't hold it's shape as well as ones that are on the harder end of the range. The origins of the myth were not based in data, but a theory and it just kept going for a century and a half (sometimes added more to texts and that than others).

5 is a little on the soft side, but if you aren't having other symptoms of IBS (no pain, no urgency, no bloating) I really wouldn't worry.

It may be worth playing with your fiber levels to see if that effects things, or do a little stress reduction as stress can speed things up, or slow things down (depending on the person) just enough to get you off the perfect part of the scale.

If you eat a lot of sugars or lactose, it may be loosening the stool a bit so you may look and see if limiting some of the fodmap foods firms things up a bit as well. If you eat things with a lot of sorbitol added (sugar free bars, candies, gum, etc) that can also loosen things up.


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## Brocksterdanza (Dec 2, 2013)

The last part may be a winner. I drink about 3-4 diet Pepsi's a day and chew sugar free gum. I bet maybe even if I am getting to the 25 grams a day of fiber, the chemicals may be softening it up even more. Think that's possible?


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## Kathleen M. (Nov 16, 1999)

Could be that you are getting enough dietary stool softening/loosening things to have an effect. You could do a trial of avoiding those things for a couple of weeks and see if it makes a difference.


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## Brocksterdanza (Dec 2, 2013)

So when should I worry about it being flattish? When and if blood shows up, or I get pencil stools? Or should I be ok with it being a little deformed as long as I am going regularly without pain, blood, etc?


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## Kathleen M. (Nov 16, 1999)

When/if blood shows up, or if you get frequent watery stools that do not seem to be just a GI infection even if you are staying hydrated.


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## Brocksterdanza (Dec 2, 2013)

Last question Kathleen. I have upped my fiber to about 30-35 grams per day. I am doing this with bran cereal, fruit and fiber one bars. How long until I should see my stool taking shape or bulking? If this doesn't do it, what are my other options to get a thicker rounder stool? Is it also possible that my anxiety about this issue could cause my stool to be flat? I read somewhere that anxiety maybe can cause your colon to do odd things. Thanks again for all your help.


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## Kathleen M. (Nov 16, 1999)

I usually think a 2 week trial of a new diet is a good idea. Lets you know where things are likely to settle out, or how much of the time the diet will help.

You may see changes (good or bad at first) sooner than that, but a couple of weeks gives you a good feel for how it is likely to go over time.

I mean you could try things that are mildly constipating, like a calcium supplement with meals if it really bothers you and you can do so safely (don't have kidney issues or other diseases that may make calcium supplements a bad idea).

And it could be the anxiety about the stool is helping to make the stool less than normal. The nerves in the gut talk to the nerves in your head and the stress hormones and all that floating around never really help the GI tract function better.


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