Why and what does light colored feces mean?

One of the indicators of the digestive system is the color of feces, the normal brown color of which is due to the presence of the final products of the breakdown of unbound bile pigment bilirubin - stercobilinogens (L-urobilinogens). Very light feces can indicate a number of diseases, some of which are potentially life-threatening. So, doctors advise not to ignore such a symptom as pale-colored (hypocholic) stool, observed for a fairly long time.

Causes of light colored stool: dietary and pathological

First of all, the reasons for light-colored stool may be related to the nature of the diet. Thus, light-colored stool in an adult is possible when eating too much fatty food or a significant amount of dairy products. In the first case, the development of acholia occurs due to the fact that lipase (an intestinal enzyme) cannot cope with the breakdown of fats, as evidenced by fatty light-colored stool (steatorrhea). And since not everyone produces enough hydrolytic gastrointestinal enzymes to digest milk protein (casein), then the consequence of their deficiency is light-colored stool from milk. And if you eat too much cottage cheese, which has more casein than whole milk, then, most likely, there will be light-colored stool from cottage cheese or light streaks in the stool (particles of undigested casein). Those who go on a kefir diet may temporarily experience light-colored stool after kefir.

When following a low-carb ketogenic diet with a significant increase in fat intake, protein may appear in the stool as light-colored, non-uniform specks in the stool.

A completely natural phenomenon that has nothing to do with pathologies is light-colored stool during breastfeeding, as well as light-colored stool in a child whose diet is dominated by dairy products and white cereals (rice cooked in milk, manna, rolled oats).

Doctors see pathological causes of hypocholine stool in problems with the functioning of the biliary system (liver, gallbladder and its ducts), as well as in negative changes in the pancreas.

When the passage of bile through the ducts is blocked - which often happens with inflammation of the gallbladder (cholecystitis), inflammation of the bile ducts (sclerosing cholangitis), formation of stones (cholelithiasis) - stagnation of bile (cholestasis) occurs with the development of mechanical jaundice. In such situations, light-colored stool and abdominal pain are combined. And light-colored stool with cholecystitis can be accompanied by frequent vomiting of bile.

In most cases, light-colored stool after gallbladder removal is the result of a narrowing of the bile ducts (biliary stricture).

A lower content of stercobilin in feces with a simultaneous increase in the level of direct bilirubin in urine - light feces and dark urine - are typical for patients with viral hepatitis - A (Botkin's disease) B, C, D, E. Even without obvious yellowing of the skin, light feces and pain in the right hypochondrium, as well as light feces and temperature most often indicate liver damage by one of these viruses and disruption of its functioning.

Inflammation of the pancreas (pancreatitis) and the associated deficiency of pancreatic enzymes are accompanied by symptoms such as diarrhea and light-colored, yellowish-gray or light-gray stools, as well as light-colored stools and abdominal pain.

Disturbances in intestinal peristalsis, light-colored liquid stool, light-colored stool with inclusions of incompletely digested food, light-brown stool with foam or light-green stool with a sour odor are included in the list of symptoms of chronic non-ulcerative colitis.

In many ways, similar symptoms are observed in:

• cirrhosis of the liver;
• biliary cirrhosis (inflammation or irritation of the bile ducts in the liver);
• cystic fibrosis of the pancreas or liver;
• enzyme deficiency associated with malabsorption syndrome;
• gluten intolerance (celiac disease), when patients experience light-colored stools and flatulence;
• Crohn's disease (mucous, light-colored stool with blood);
• cancer of the head of the pancreas or malignant tumor of the liver;
• cancer of any localization (due to a decrease in the synthesis of erythropoietin and a decrease in the level of red blood cells in the blood);
• Gilbert's syndrome, a congenital disorder caused by a deficiency of the liver enzyme uridine diphosphate glucuronyl transferase; symptoms include nausea and vomiting, light-colored stools and pain in the right upper quadrant, diarrhea or hard, light-colored stools, loss of appetite, and fatigue.

Light-colored liquid feces with mucus, light-colored feces with foam, as well as foul-smelling light-green feces - against the background of nausea with vomiting, painful spasms in the intestines and fever - often occur with dysentery (damage by Shigella bacteria), salmonellosis (caused by enterobacteria Salmonella enterica) or giardiasis. And such parasitic invasions as ascariasis and abdominal paragonimiasis (dystomatosis) can lead to blockage of the bile ducts by fibrous cysts that form around colonies of larvae of these nematodes.

Rotavirus infection (stomach flu), in addition to respiratory symptoms, is characterized by liquid light-colored stool after rotavirus. Nausea, vomiting, diarrhea and foamy light-colored stool after enterovirus appear.

Light-colored stools are observed after poisoning with lead (with the development of toxic sideroblastic anemia), phosphates or arsenic.

Pathologies in which light-colored, almost white feces are observed are listed in the publication - White feces in adults and children

Why does stool become light-colored during pregnancy? For more details, see – Change in stool color during pregnancy

If light-colored stool appears after drinking alcohol (or rather, excessive drinking), then the whole point is damage to hepatocytes and the development of acute alcoholic hepatitis.

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Pathogenesis and risk factors

The pathogenesis of the loss of normal stool color is known: a decrease in the level of stercobilin (an oxidation product of L-urobilinogens). And risk factors include: nutritional disorders, inflammation or damage to liver cells, problems with the gallbladder and its ducts, an imbalance of the main peptide gastrointestinal hormones (produced in the duodenum and jejunum) or pancreatic enzymes.

Experts note that in the absence of cholestasis, the level of bile pigments may be reduced as a result of deviations in the blood composition with a decrease in the number of erythrocytes. After all, bile pigments are formed during the natural breakdown of red blood cells and the release of hemoglobin - in the process of sequential transformation of heme into biliverdin, biliverdin into bilirubin, and bilirubin into L-urobilinogen.

In turn, the etiology of the decrease in the level of red blood cells has several reasons: from a lack of nutrients (with protein starvation) and blood loss of various etiologies (this explains light-colored feces after childbirth) to a high dose of ionizing radiation and long-term intoxication of the body. In addition, a low level of red blood cells is noted with:

• anemic conditions;
• myelodysplastic syndrome;
• congenital deficiency of the blood enzyme G6PD (glucose-6-phosphate dehydrogenase);
• elevated levels of proteins in the blood (which can be caused by hyperthyroidism, renal failure due to chronic inflammation, increased secretion of adrenal cortex hormones, malignant tumors, etc.).

The process of oxidation of hemoglobin leads to the formation of the green pigment choleglobin, which in the course of further metabolism is transformed into bilirubin (binding with glucuronic acid, broken down by the liver and excreted with bile). However, if the chyme passes through the stomach and intestines too quickly, choleglobin enters the large intestine, causing light green feces.

Another option - when greenish light feces are observed with dysbacteriosis - is associated with the fact that, passing through the intestines, bilirubin is largely not oxidized to stercobilinogen, since it is not exposed to the microbiota (obligate intestinal microflora) present in it - due to the death of beneficial bacteria.

Light colored stool and medications

Doctors pay special attention to medications as risk factors for the development of hypochondriasis in patients.

First of all, this concerns numerous complaints about light-colored stool after antibiotics, in particular, the penicillin group, tetracycline and cephalosporins, as well as sulfonamides. This side effect of antimicrobial agents is explained by their effect on such beneficial intestinal bacteria as Bifidobacterium, Lactobacillus, saprophytic destructors, etc.

Nonsteroidal anti-inflammatory drugs (Ibuprofen, etc.), oral contraceptives and anabolic steroids can cause acute and chronic drug-induced hepatitis.

In most patients, light-colored stools in diabetes are the result of a side effect of hypoglycemic drugs taken. For example, when using sulfonamides (sulfonylurea derivatives - Gliclazide, Gliquidone, Glimepiride, etc.), side effects may occur in the form of nausea, vomiting, diarrhea, cholestatic jaundice and drug-induced hemolytic anemia. And the use of antidiabetic agents of the α-glucosidase inhibitor group (Acarbose or Miglitol) is often accompanied by severe dyspepsia due to poor digestion of carbohydrates, which begin to break down only in the intestine, causing light-colored stools and flatulence.

Also, numerous antacids that neutralize gastric acid stand out in this regard. Thus, the light color of feces after Fosfalugel appears due to the presence of aluminum phosphate in this product, which adsorbs cholic and chenodeoxycholic acids of bile, as a result of which the emulsification of fats coming with food is reduced.

The intestinal sorbent Enterosgel is a hydrogel of methylsilicic acid, and the light color of feces after Enterosgel is a consequence of bilirubin adsorption. And light feces after Motilium, which is used for better digestion with sluggish bowel function, can be caused by magnesium stearate (increasing the formation of mucus in the stomach and acting as a laxative). In addition to it, such insoluble components as polyvinylpyrrolidone (povidone) and microcrystalline cellulose are adsorbents and are excreted unchanged by the intestines.

For diarrhea, it is recommended to take Loperamide (Imodium), which acts on opioid receptors and reduces intestinal peristalsis. At the same time, Loperamide causes light-colored stool due to the suppression of hydrochloric acid production in the stomach and the deterioration of food digestion.

If you take the herbal medicine Sinupret for a cough, then Sinupret may cause light-colored stool due to the action of the auxiliary substances included in its composition. 100 ml of Sinupret drops contain 29 g of alcohol-water extract of medicinal plants, and the same amount of syrup contains only 10 g; the remaining (auxiliary) ingredients include: glycol wax, povidone, thickeners and stabilizers (talc, potato starch and corn dextrin), silicon dioxide, magnesium oxide, etc.

Consequences and complications

One of the most common complications of light-colored stool is jaundice - with yellowing of the skin and whites of the eyes. And the consequence is most often a serious decrease in the functions of the liver and gallbladder.

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Diagnosis of light colored stool

Diagnosis of diseases that cause this symptom necessarily begins with anamnesis and complete information about accompanying symptoms and medications that the patient is taking.

Tests include:

• stool analysis (clinical coprogram) with determination of stercobilin levels;
• analysis of feces for intestinal bacteria, nematode larvae and helminths;
• clinical blood test;
• biochemical blood test for levels of bilirubin, cholesterol, bile acids, liver and pancreatic enzymes;
• blood test for immunoglobulins;
• general urine analysis and urine analysis for urobilinogens;

Instrumental diagnostics of pathologies in which light-colored stool is observed may include:

• abdominal ultrasound (gallbladder, liver, pancreas);
• X-ray of the intestines;
• radioisotope scanning (scintigraphy) of the gallbladder, liver and bile ducts;
• cholangiography;
• computed tomography of the digestive and biliary systems;
• magnetic resonance cholangiopancreatography.

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Differential diagnostics

Differential diagnostics – based on the results of tests and instrumental examination – should reveal the real etiology of this symptom.

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Treatment of light colored stools

Nobody treats light-colored stool: it is necessary to treat not the consequence, but its cause. And it is clear that the treatment for gallstones will be completely different than for non-ulcer colitis or pancreatitis.

It is simply impossible to cover treatment methods for all the pathologies mentioned within the framework of one publication.

How to treat inflammation of the gallbladder is described in detail in the material - Chronic cholecystitis

What medications and folk remedies are used for liver damage by the hepatitis virus, see in detail – Hepatitis B Treatment

Also read:

• Medicines for acute and chronic pancreatitis
• Treatment of giardiasis

Prevention

Experts say that many problems with the gallbladder, liver and intestines can be prevented by proper prevention. However, liver cirrhosis or autoimmune biliary cirrhosis can be fatal. Congenital syndromes and enzymopathies cannot be prevented. However, some forms of hepatitis have vaccines.

Read more:

• Prevention of hepatitis A
• Prevention of dysentery
• Enterovirus infections Treatment and prevention

Forecast

Once the underlying cause of light-colored stool is treated, the stool should return to its normal brown color. However, some causes, such as liver disease and some cancers, are incurable.