General stool analysis and its interpretation

A general stool analysis (coprogram) is one of the basic laboratory tests. It is prescribed to assess the functioning of the digestive system and diagnose related pathologies. Sometimes, there is confusion about the correct term for the stool test, whether it is a “general” analysis or a “coprogram.” Both terms are correct; the former is more commonly understood by most people. The latter is named after the science of coprology, which studies excrement.

Indications for a general stool analysis: This test is usually the first step in diagnosing digestive issues when a patient has complaints such as:

  • Painful sensations or spasms
  • Heartburn, nausea
  • Bloating
  • Constipation or diarrhea
  • Visible impurities in the stool (mucus, blood, pus, undigested food)
  • Acne
  • Allergic reactions
  • Symptoms of helminthiasis (fatigue, weakness, fever, abdominal pain, muscle pain, bloating, dry cough)

A coprological analysis is needed if there is suspicion of gastrointestinal pathologies or if they have already been diagnosed and need to be monitored for progression or treatment effectiveness. Such tests are frequently prescribed in the following conditions:

  • Stomach or duodenal ulcers
  • Irritable bowel syndrome
  • Colitis and enteritis, including Crohn’s disease
  • Pancreatitis
  • Cirrhosis of the liver
  • Chronic constipation
  • Diverticulosis
  • Anal fissures
  • Hemorrhoids

Coprological tests are also crucial for infectious diseases, especially when isolation of the patient is necessary.

What a coprogram shows: A stool analysis involves evaluating the stool’s physical properties and composition through visual inspection, microscopy, and chemical tests.

  • Consistency: Normally, stool should have a well-formed, firm consistency, which depends on diet and hydration. Stool is 70-75% liquid, with the rest made up of undigested food, dead bacteria, and cells from the intestinal lining.

    Changes in stool consistency may indicate:

    • Clay-like stool: Insufficient bile entering the intestines.
    • Oily consistency: Dysfunction of the pancreas (chronic pancreatitis, cholecystitis, gallstones).
    • Mushy stool: Fermentative dyspepsia, enteritis, irritable bowel syndrome, or a diet high in fat.
    • Watery stool: Pathologies of the large intestine, malabsorption in the small intestine.
    • Ribbon-like stool: Anal fissures, chronic hemorrhoids.
    • Goat or sheep-like stool: Associated with spastic, allergic, or atonic colitis, irritable bowel syndrome, constipation, or stenosis of the large intestine.
    • Frothy stool: May indicate dysbiosis or colitis.
  • Color: Normal stool color is brown, due to the bile pigment stercobilin. Changes in color can indicate pathology or dietary factors:
    • Light brown: Accelerated intestinal peristalsis or a diet high in plant-based foods.
    • Dark brown: Digestive disturbances, colitis, constipation, or a high-protein diet.
    • Pale stool: Mechanical jaundice, pancreatitis.
    • Green stool: Increased bile pigments, rapid intestinal peristalsis.
    • Greenish-black stool: Iron supplementation.
    • Bright red: Indicative of bleeding in the colon or rectum.
    • Black tarry stool: Gastrointestinal bleeding (upper GI tract).
  • Smell: Stool naturally has a distinctive odor, which can vary based on food, medications, or health conditions:
    • Sour: Fermentative dyspepsia.
    • Foul-smelling: Pancreatitis, hypersecretion in the large intestine, or cholecystitis.
    • Rotted odor: Putrefactive dyspepsia, colitis, gastric digestion issues.
    • Oily: Stools with an accelerated evacuation from the large intestine.
  • pH: The normal pH level of stool is 7-7.5. Factors like diet and medications can shift the pH:
    • pH >8.5: Alkaline reaction (putrefactive dyspepsia).
    • pH 8-8.5: Alkaline reaction with constipation or inflammation.
    • pH 7.8-8: Mild alkaline reaction due to poor digestion.
    • pH <5.5: Acidic reaction associated with fermentative dyspepsia.

Microscopy and Chemical Testing: Stool composition can reveal digestive system issues:

  • Mucus: A small amount is acceptable in infants on breastfeeding. Its presence in others may indicate celiac disease, irritable bowel syndrome, or gastrointestinal infections.
  • Muscle and connective fibers: Indicate pancreatic pathologies or digestive insufficiency.
  • Plant fibers: Indicate disturbed digestion in the small intestine.
  • Fatty acids: Found in slow digestion or bile duct obstructions.
  • Neutral fat: Found when pancreatic enzymes are insufficient.
  • Starch: Indicates pancreatic dysfunction or slowed digestion.
  • Soluble protein: Found in gastrointestinal bleeding, inflammatory processes, or ulcers.
  • Worm eggs: Indicate helminthiasis.
  • Leukocytes: Sign of inflammation or ulceration in the intestine.
  • Erythrocytes: May indicate hemorrhoids, anal fissures, polyps, or gastrointestinal cancer.

Preparation for Analysis: The stool sample should be collected in a clean, dry container. Before collecting the sample, the patient should empty their bladder, wash the genital area and anus, and collect the stool in a clean container. The sample should be stored in the refrigerator if it can’t be delivered immediately.

Important Notes:

  • Avoid using enemas or medications affecting digestion the day before or on the day of collection.
  • Certain foods like eggs, tomatoes, and beets should be avoided for 48 hours before the test.
  • Blood from the gums or menstruation can affect the results, so it’s advisable to avoid collection during these times.

Interpreting the coprogram results should be done by a specialist, who will consider the patient’s symptoms, examination findings, and other tests to make an accurate diagnosis.

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