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Let’s Talk About Poop

Let's Talk About

Typography graphic spelling “Pooooop,” with letterforms modified by stool shapes inspired by the Bristol Stool Chart

Diaper Check

We need to talk about poop because there’s really a stigma that exists to doing so. And unfortunately, by not talking about it, people are not diagnosed quickly with some diseases that are very treatable. 

Parents see if there is blood in their baby’s poop. But as soon as your child goes to the bathroom by themself, you most likely will not look at their poop. Older children, adolescents, are likely too embarrassed to talk about it. But I would encourage people to try to get over this. Nearly one in a hundred Canadians has inflammatory bowel disease (IBD). This used to be a disease of people in their 20s or older. But now it’s quite common to see it in children, very young children, even under the age of two. At The Hospital for Sick Children (SickKids), we have a big IBD program, with more than 1,500 patients from across the Greater Toronto Area. My clinic is unique. We only see kids under the age of two with IBD, and mostly kids who are showing the most severe symptoms of the disease. 

We still don’t know why some children develop IBD. The most important thing to know is that it’s no one’s fault. Usually, it’s just bad luck.

Kids with IBD get up at night to go to the washroom. They can go to the washroom 10 to 15 times during the day. They don’t eat because they don’t feel well, and so they don’t grow. The goal is to have none of those problems.There are many good treatments now that will allow you to live a normal life. That’s why I want more people to seek treatment and get an early diagnosis. This all starts with talking about poop.

Aleixo Muise (MD ’01, PGME ’06, PGME ’08) is a professor in Temerty Medicine’s Departments of Paediatrics and Biochemistry, as well as the Institute of Medical Science. He is also a clinician scientist at SickKids and holds the Canada Research Chair in Pediatric Inflammatory Bowel Disease. 


Accidents Happen

We tend to treat bowel movements as something to just flush and forget. But stool is one of the most important daily health indicators we have. When stool changes, your body’s sending you a signal. So, take a look in the bowl, instead of just flushing and going on your merry way. 

When I talk to patients about stool, one of the areas we discuss is fecal or bowel incontinence, which is the inability to control the passage of stool or gas, resulting in accidental leakage.

Research shows that 7 per cent of men around the world experience fecal incontinence and 10 per cent of women go through the same thing. It is very much treatable. I hate to hear people come in and say, “Oh, I’m just leaking and that’s just part of life.” There are actually a lot of things we can do. 

People ignore leakage because they don’t know what’s normal, and because people feel shame when talking about it. Fecal incontinence is not addressed in research much because people don’t disclose their symptoms, and clinicians don’t ask about it because they feel uncomfortable. If people are embarrassed, they may wait years to get care until, sadly, it can be too late. When we normalize the conversation about leakage, we can improve research, we can improve screening, and we can improve outcomes. 

Olivia Drodge (MSc ’16) is an adjunct lecturer in Temerty Medicine’s Department of Physical Therapy and a pelvic health physiotherapist at Women’s College Hospital. She is also a PhD student at Temerty Medicine and University Health Network’s Wilson Centre.


The Lynch Syndrome Link

Researchers estimate that one in 279 people has Lynch syndrome. And people who have Lynch face a greatly increased risk of developing several kinds of cancer. Two cancers that frequently occur with Lynch are colorectal and endometrial cancers. However, Lynch syndrome can lead to cancer in many other organs, including cancer in the pancreas, kidneys, brain, stomach and bladder. 

If the estimates are correct, that means there are more than 140,000 Canadians who could have one of five inherited genetic variants grouped as Lynch mutations. But estimates also indicate that many people who have Lynch syndrome are not aware they have the condition — and neither are their doctors. And that’s a big problem. 

If you know you’ve got Lynch and a higher risk of cancer, and if your doctors understand this too, you can be monitored so that if cancer does develop, you have a much better chance of being treated early and successfully. This can be life-saving. 

In my own case, I knew there were cancers in my family. Upon learning I had endometrial cancer, I had to do my own research to learn about Lynch.  None of the medical people I’d been dealing with up to that point had talked to me about it. I am grateful my husband, James Rutka (PGME ’89), who was then Chair of Neurosurgery at the University of Toronto, supported my decision to ask for Lynch genetic testing.  As we suspected, I had Lynch syndrome. 

More recently, I have had breast cancer, which can also sometimes be due to a Lynch mutation. Fortunately, having caught my cancers early, I’m OK. However, I still need to be monitored regularly for colorectal, dermatological and other cancers. My background knowledge allowed me to persist in pursuing treatment. Not everyone is so lucky. 

There is still surprisingly little coordinated monitoring and support for Lynch patients within our medical system. In 2020, I helped start a Lynch patient support group. We share our experiences and hear about research developments and medical recommendations from experts. But thousands are still unaware of Lynch syndrome, as are their doctors. I very much hope this changes.  

Mari Rutka is the co-ordinator of a Lynch syndrome support group based in Toronto. Her husband James Rutka served as the Dan Family Chair of the Division of Neurosurgery at Temerty Medicine from 1999 to 2011, and the R.S. McLaughlin Professor and Chair of the Department of Surgery at Temerty Medicine from 2011 to 2022.