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Introduction ⬇

The brown color of normal stool is probably due to stercobilin (end product of heme catabolism), a bile pigment derivative, which results from the action of reducing bacteria in bilirubin and other undetermined factors.

The first indication of GI disturbances is often a change in the normal brown color of the feces. A change in color can provide information about pathologic conditions, organic dysfunction, or intake of drugs. Color abnormalities may aid the healthcare provider in selection of appropriate diagnostic chemical and microbiologic stool tests.

Normal Findings ⬆ ⬇

Brown

Procedure ⬆ ⬇

Collect a random, fresh stool specimen following the procedure for Collection and Transport of Random Specimens. Observe standard precautions.

Clinical Implications ⬆ ⬇

The color of feces changes in some disease states as follows:

  1. Yellow, yellow-green, or green: severe diarrhea

  2. Black, with a tarry consistency: usually the result of bleeding in the upper GI tract (more than 100 mL blood)

  3. Maroon, red, or pink: possibly the result of bleeding of the lower GI tract from tumors, hemorrhoids, fissures, or an inflammatory process

  4. Clay colored (tan, gray, or white): biliary obstruction

  5. Pale, with a greasy consistency: pancreatic deficiency causing malabsorption of fat

Clinical Alert

Grossly visible blood always indicates an abnormal state.

  1. Blood streaked on the outer surface of stool usually indicates hemorrhoids or anal abnormalities.

  2. Blood present in stool can also be caused by abnormalities higher in the colon. If transit time is sufficiently rapid, blood from the stomach or duodenum can appear as bright red, dark red, or maroon in stool.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain purpose of test, procedure for stool collection, and interfering factors. Ask the patient to notify the healthcare provider about stool color changes.

  2. Record dietary and drug history.

  3. Advise the patient to avoid barium procedures and laxatives and for 1 week before specimen collection.

  4. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Report and record abnormal appearance and colors of stool. Modify the nursing care plan as needed. Counsel the patient regarding the meaning of color changes and explain the need for further testing (e.g., GI studies).

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆

  1. Stool darkens on standing.

  2. The color of stool is influenced by dietary intake, food dyes, and drugs (see Appendix E).

    1. Yellow-rhubarb, yellow to yellow-green color occurs in the stool of breast-fed infants who lack normal intestinal flora.

    2. Pale yellow, white, or gray stools can be due to barium intake.

    3. Green color occurs with diets high in chlorophyll-rich green vegetables such as spinach or with some drugs (see Appendix E). An increase in biliverdin, green pigment formed during hemoglobin breakdown, may also contribute to green color.

    4. Black color may be due to foods such as cherries, a high proportion of dietary meat, artificially colored foods such as black jellybeans, or drugs and supplements such as charcoal, bismuth, or iron.

    5. Light-colored stool with little odor may be due to diets high in milk and low in meat.

    6. Claylike color may be due to a diet with excessive fat intake or to barium intake.

    7. Red color may be due to a diet high in beets or tomatoes, red food coloring, or peridium compounds.

    8. Certain color changes may result from specific drugs (see Appendix E).

Clinical Alert

A complete dietary and drug history will help to differentiate significant abnormalities from interfering factors