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Celiac disease poop can be crappy (pun intended). This post will decode what your celiac poop is telling you about your health and healing.
The goal is for your toilet bowl to contain more answers than questions.
This post was written with the help of dietetic intern Abby Pitman.
When it comes to celiac disease poop, it’s good to know what healthy poop looks like. Your mental image of a healthy poop might be close to the poop emoji. If so, you are not far off.
While the iconic swirl isn’t often present (or the smiling face), a healthy poop should resemble the emoji in a few ways. The qualities of a healthy poop include:
All of those things together are a sign of a healthy celiac bowel movement.
Unhealthy poops are often reduced to either severe diarrhea or constipation. While severe constipation or diarrhea are certainly worrying bowel movements, unhealthy poops include other symptoms, such as:
*According to John Hopkins, constipation occurs when an individual has fewer than three bowel movements per week. There is a misconception that constipation only occurs when you are unable to have a bowel movement for a much longer period of time.
If you’re a visual learner, understanding celiac disease poop via the Bristol Poop Chart may be helpful. The Bristol Stool Chart is a tool to easily evaluate your poop based on its shape and overall form. The chart divides stool into seven types with 1 being the most firm and 7 being the loosest.
Type 3 or 4 are your poop goals: well-formed and passed without pain. Your poop is moving through your body at a good speed, and you’re likely consuming appropriate amounts of water and fiber. This is the general healthy poop range.
Types 1 and 2 are harder and often painful to pass. These lumpy, hard poops point to constipation. You may also notice bloating, abdominal pain, or painful straining as the hard lumps slowly move through your digestive system.
On the opposite end of the Bristol Stool Chart are Types 5, 6 and 7. All three have passed through the digestive system too quickly, leading to overly soft poops. Type 6 and 7 are when you’re reaching diarrhea levels.
Often a question people wonder about celiac disease poop is should it float or sink? On average, water makes up 75% of your poop. The other 25% consists of solid material, like fiber, protein, indigestible fat, and bacteria.
A healthy poop (with appropriate amounts of solid material) makes a “plop” when it hits the toilet and sinks to the bottom.
Floating poop is lacking that dense material that bulks up your poop. The water content is higher than normal, causing a floater. Another culprit for floating poop is gas. Swallowing a lot of air while eating or eating foods that release a lot of gas can lead to excessive gas getting trapped in your poop, making it float.
The occasional floating poop is not a reason for major concern. It can temporarily be caused by eating foods that make you gassy or a minor stomach bug. It’s time to see a doctor if your poop floats more often than it sinks, as malabsorption, chronic gas or IBS may be the cause.
Celiac disease poop has some key characteristics. As a celiac, monitoring your bowel movements is a great way to keep tabs on your intestinal healing.
Damaged intestines cannot absorb sufficient amounts of nutrients, leading to malnutrition. Malabsorption poops are greasy, floating bowel movements that smell awful.
The oily or greasy appearance can be caused by poorly digested fat remaining in your poop. Due to this improperly absorbed fat, malabsorption poops may stick to the side of your toilet bowl and can be difficult to flush.
Additionally, ongoing diarrhea is not uncommon with malabsorption.
The last place you want to see a colorful rainbow is in your toilet bowl. While healthy poops do have a surprisingly wide range of acceptable shades, there are certain colors that you want to look out for.
One-off or infrequent colorful poops shouldn’t send you rushing to the ER. Often, the source of unusual colors resides in your diet. Food coloring, iron supplements, medications, or colorful vegetables (leafy greens, carrots, sweet potatoes, beets, cranberries, etc) may be causing your colorful poops.
However, if a funky color sticks around for more than a couple days, speak to your healthcare provider about it.
While alluded to briefly in previous paragraphs, celiac disease affects poop in a variety of ways. Most importantly to note, if you are still healing or have unmanaged celiac, the autoimmune reaction and intestinal damage can impact your poop in some specific ways.
In some untreated celiacs, bowel movements may be hard to pass and painful, loose or watery, and/or yellow or pale. Long-term diarrhea or constipation (or alternating between the two) is common.
Unsurprisingly, research has shown that untreated celiac patients (those not adhering to a gluten-free diet) had more indigestion, diarrhea, and abdominal pain than those keeping a GF diet. As you adopt a gluten-free diet and your intestines heal, your poops should normalize.
However, the same study also found that treated celiac patients still experienced more gastrointestinal symptoms than non-celiacs. Long-term treated women experienced more symptoms than their male counterparts. Once gluten was ruled out as a potential cause (as shown by well-recovered histology and antibody levels), other potential causes of persistent symptoms include small-intestinal bacterial overgrowth, and concomitant disorders (IBD, microscopic colitis), or refractory celiac disease.
Research continues to look into how the diversity of duodenal microbiota interacts with the gastrointestinal symptoms; one study found that GF celiacs with persistent symptoms had different duodenal microbiota than GF celiacs without symptoms.
Celiac is not a one-size-fits-all, despite the misconception that treatment and healing is immediate after going gluten-free. Some celiacs will take longer than a year to see relief from symptoms; others will continue to have mild to moderate gastrointestinal symptoms despite a strict and long-term GF diet.
Celiac disease poop will look different depending on what phase of treatment you’re in. Meaning, celiac poop will look different with untreated, healing, and a healed small intestine
In celiacs with intestinal damage (untreated, undiagnosed, or still healing), abnormal or unhealthy poops are to be expected. This ranges from pooping too much, pooping too little, diarrhea, and/or constipation.
Celiac disease poop can come in all colors however, yellow poop, which is caused by malabsorption, may be highly indicative of celiac disease. This is because bile begins as a yellow/yellow-green color, and enzymes change it to brown shade as it moves through the GI tract.
The brown tint is also caused by bilirubin, a pigment resulting from the breakdown of red blood cells. In untreated or healing celiacs, food moves through the GI system faster, preventing bilirubin from accumulating properly in the poop.
Additionally, celiac disease may cause malabsorption of fat, leading to excess fat being passed in the poop. Together, the lack of bilirubin and increased fat causes yellow poops.
Mucus may also be present on poop as a result of the damage done to your GI tract. These bowel movements may feel normal if you have had the symptoms for a long period of time, which is why knowing what healthy poops should look like is so important.
In celiacs on a gluten-free diet with functioning villi, gluten exposure can cause temporary inflammation and abnormal poops. Celiacs following a gluten-free diet may also experience constipation, due to the potential lack of fiber in a gluten-free diet.
Grains with gluten are a major source of dietary fiber. By avoiding grains with gluten, celiacs risk not getting enough fiber. Don’t be too scared though – a balanced gluten-free diet with sufficient fiber is possible!
Ultimately, your celiac disease poop should be normal if your celiac is managed. If you need help with figuring out how to manage celiac disease and you need tools to heal after a celiac diagnosis, I cover all of the basics in the Celiac Crash Course.
That being said, if you are managing your celiac and your poop is unhealthy, it could be a sign that something else is going on. You definitely want to bring up these concerns with your celiac dietitian and doctor. If you need help finding a celiac dietitian, I’m happy to help.