The red flags that may be hiding in your poop

Dr. Trisha Pasricha, a gastroenterologist and medical journalist, once encountered a case so unusual it was written up in the New England Journal of Medicine: a patient whose stool came out as a "silver bullet, beautiful diamondy silver poop." The cause was two emergencies happening at once — a bleeding stomach ulcer that turned the stool tarry black, combined with a blockage that made it white, producing a silver sheen. "Take a pic, but definitely go right to the emergency room," she says.

That extreme example opens a broader conversation about why paying attention to your stool matters more than most people realize. Since the 1990s, colon cancer rates have been rising among people under 50. In 2018, the American Cancer Society lowered the recommended screening age from 50 to 45. Colonoscopies save lives, Pasricha emphasizes, "not because they detect cancers" but because they prevent them — by removing polyps before they turn malignant. About five to ten percent of those growths would become cancer if left alone.

Yet roughly one in three people avoids talking to their doctor about bowel habits out of embarrassment. "I really do think that this deep stigma we have about talking about pooping and talking about our bowels is tied to these cases in some ways," Pasricha says.