The red flags that may be hiding in your poop

Summary

Short Wave – "The Red Flags That May Be Hiding In Your Poop"

Podcast: Short Wave (NPR)
Hosts: Regina Barber
Guest: Dr. Tricia Pasricha, gastroenterologist & medical journalist
Date: August 7, 2026
Duration: ~13 minutes (content excluding ads, intro, outro)

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Episode Overview

This episode dives humorously yet candidly into the science and health implications of your poop. Host Regina Barber and Dr. Tricia Pasricha discuss why stool changes matter, what certain colors signal, the importance of breaking the poop-taboo, how diet is affecting early-onset colon cancer rates, and practical "life hacks" for healthier, less stinky bathroom experiences. With facts, fun metaphors, and zero-shame real talk, the episode encourages listeners to pay closer attention to what comes out—because sometimes, it can save your life.

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Key Discussion Points & Insights

1. The Science (and Emergencies) in Stool Color

• Rare but dangerous: Silver poop
  • “A silver poop is so rare, but it is possible…” – Dr. Tricia Pasricha [00:45]
  • Caused by simultaneous stomach bleeding (black, tarry stool) and bilirubin blockage (white stool), resulting in silvery appearance.
  • “As fun and interesting as it may look, it’s also a sign to take immediate action.” – Regina Barber [01:35]
  • Takeaway: If you ever see this, snap a pic—but immediately seek emergency care.
• Red and black: Literal red flags
  • Blood (red/maroon) or black, tarry stool can both signal internal bleeding and require immediate attention.
  • “Red and black, bad.” – Regina Barber [06:02]; “Yes.” – Dr. Tricia Pasricha
• Other notable colors:
  • Yellow/Green: Can be normal (often diet-related), but with illness/diarrhea, may signal infection [07:33].
  • White/Clay: Always an emergency; could be gallstones, cancer, or bile duct obstruction.

2. Colon Cancer Is Striking Younger People

• Rates among people under 50 are rising.
• The American Cancer Society has lowered initial screening age from 50 to 45 [01:43].
• Colonoscopies save lives:
  • “They prevent cancers, not because they detect cancers.” – Dr. Tricia Pasricha [02:01]
  • By catching and removing polyps before they turn cancerous.

3. Embarrassment = Dangerous Delay

• About 1 in 3 people avoid talking to doctors about poop due to embarrassment [02:28].
• Early-onset colorectal cancer too often gets diagnosed late as a result.
• “This deep stigma… is tied to these cases in some ways.” – Dr. Tricia Pasricha [02:28]

4. The Bristol Stool Scale: Poop Types 1–7

• Type 4: the “perfect, smooth, snake-like stool” (dream poop!) [04:21]
• Type 1: hard little pellets (too long in the colon); Type 7: watery diarrhea.
• Most Americans: Type 3 or 4 (pretty healthy).

5. Common Causes of Color and Shape Changes

• Blood: Obvious red flag—NOT from beets or red wine, though those can color stool too.
• “Unless you’ve had beets… you’ll get a pass for one maroon-colored stool.” – Dr. Tricia Pasricha [05:39]
• Alcohol: Large quantities of red wine can turn poop purple [07:00].
• Diets (like keto): Can make stool more yellow and fatty.

6. When to See a Doctor: Red Flags

• Blood (red/black), new pain (even dull), unintended weight loss, iron deficiency/anemia [06:03].
• Most important: A change in your bowel habits.
  • “It requires you looking every day, you have to know what’s normal for you.” – Dr. Tricia Pasricha [06:57]

7. Life Hacks for Healthier, Less Stinky Bathroom Moments

• Pepto-Bismol & fart hacks:
  • “You can take Pepto-Bismol beforehand… It binds sulfur-producing gases and you’ll be able to kind of neutralize that sulfur.” – Dr. Tricia Pasricha [08:40]
  • Safe for short-term use, but “your poop will be black.” [09:25]
• Pro tip: Don’t use it long-term, especially with aspirin.

8. Why Are Colon Cancer Rates Rising in Young People?

• “One of the most common etiologies… is our diet. And it is specifically ultra-processed foods.” – Dr. Tricia Pasricha [09:47]
  • Such foods increase inflammation and are low in fiber.
  • Early dietary habits (during childhood/adolescence) are significant risk factors.

9. What You Can Do: Poop Better, Live Healthier

• Fiber is king:
  • “The first thing I ask myself… is what have I done to feed my microbiome today?” – Dr. Tricia Pasricha [11:14]
  • Good microbes need fiber; aim to meet your daily fiber goal.
• Probiotics/fermented food:
  • “If I can, I try to eat something fermented every day… Greek yogurt, sauerkraut, kimchi…” [11:14]
  • Large studies show fermented foods benefit gut microbe diversity.
• Treat your gut like a “delicate brain” – the enteric nervous system is vital to health [11:14].

10. The Call to End Poop Taboo

• Regular, open talking and daily observation could literally save lives.
• “I hope that our discussion helps other people talk about their poop.” – Regina Barber [12:54]

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Notable Quotes

• “A silver poop is so rare, but it is possible…there was a person…experiencing two emergencies…a silver bullet.” – Dr. Tricia Pasricha [00:45]
• “Colonoscopies save lives because they prevent cancers, not because they detect cancers.” – Dr. Tricia Pasricha [02:01]
• “This deep stigma we have about talking about pooping…is tied to these cases in some ways…” – Dr. Tricia Pasricha [02:28]
• “Red and black, bad.” – Regina Barber [06:02]; “Yes.” – Dr. Tricia Pasricha
• “You can take Pepto Bismol beforehand…binds those sulfur producing gases…and so you’ll be able to kind of neutralize that sulfur.” – Dr. Tricia Pasricha [08:40]
• “Meet your fiber goals, that’s 1, 2, and 3—and then toss in a little fermented food.” – Dr. Tricia Pasricha [11:14]

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Timestamps Guide

• 00:45 – Silver poop: Rare sign of simultaneous medical emergencies
• 01:43 – Colon cancer trends & colonoscopy
• 02:17 – Why people avoid discussing bowel changes
• 04:21 – Bristol Stool Scale explanation
• 05:39 – Colors to watch for (blood, black, white, beets, wine)
• 06:57 – The importance of knowing your “normal”
• 08:40 – Pepto-Bismol for less stinky gas and its side-effects
• 09:47 – Causes of rising young-onset colon cancer
• 11:14 – Practical daily gut health habits

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In Summary

This episode marries the serious and the silly—delivering life-saving information about colon health, de-stigmatizing bathroom talk, and arming listeners with easy-to-apply hacks for happier (and sometimes stealthier) toilet time. Take-home: Know your normal, notice changes, embrace fiber and fermented foods, and don’t let embarrassment keep you from seeking the care you may need. Your poop could be giving you an essential heads-up, if you’re brave enough to check.

Share this episode—especially with someone overdue for a colonoscopy!

Transcript

[NPR Sponsor Announcer]

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[Regina Barber]

you following Short Wave yet? It's the best way to get new episodes as soon as they drop. Look for the follow button at the top of our show page in your podcast app of choice or in Apple. It's a plus sign. Give it a little tap and you're good to go. All right, here's the show. You're listening to Short Wave from npr. It's time to talk about something we all have in common, our poop. Starting with the interesting shades it might come in.

[Dr. Tricia Pasricha]

A silver poop is so rare, but it is possible that it was written up in the New England Journal of Medicine a few years ago. And what had happened was there was a person who was simultaneously experiencing two emergencies and.

[Regina Barber]

And who better to talk about it with than Dr. Tricia Pasricha, a gastroenterologist and medical journalist. Talking with her was a good reminder to me that paying attention to your stool could save your life, especially in the case of silver poop.

[Dr. Tricia Pasricha]

They had an ulcer in their stomach and it was bleeding and it caused their poop to turn that tarry, sticky, shiny black. But at the same time, there was something blocking their bilirubin. So then they had this white stool made mixed with the shiny black and it came out this like silver bullet. Beautiful diamond y silver poop.

[Regina Barber]

As fun and interesting as it may look, it's also a sign to take immediate action.

[Dr. Tricia Pasricha]

Yeah, take a pic, but definitely go

[Emergency Room Advice Announcer]

right to the emergency room.

[Regina Barber]

Tricia says there's another reason to keep an eye on your number twos. Since the 1990s, the rates of colon cancer have increased among people under 50 years old. In 2018, the American Cancer Society lowered the recommended age for people screening from 50 to 45 years old, which can mean a colonoscopy.

[Dr. Tricia Pasricha]

Colonoscopies save lives because they prevent cancers, not because they detect cancers. We catch these polyps, which are these growths that are not yet cancer. But, you know, 5 to 10% of them will go on to become cancer if we don't remove them.

[Regina Barber]

For folks who haven't gotten their colonoscopy, Tricia says one of the biggest indicators that you need to see a doctor is a change in the color, shape, or frequency of your bowel movements.

[Dr. Tricia Pasricha]

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 because about one in three people will avoid talking to their doctor about their bowel habits because they're so embarrassed by them. And when it comes to early onset colorectal cancer, one of the biggest problems is that we're catching these cases late.

[Regina Barber]

So today on the show, why paying attention to your poop could prevent colon cancer plus life hacks to keep you healthy and stinky free. I'm Regina Barber and you're listening to shortwave, the science podcast from npr.

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[Regina Barber]

Tricia, we're talking a lot about the fact that our poops can change and those changes are worth noting to your doctor. So let's give people some foundation on how their poops can look like. There's this scale called the Bristol scale and it's like basically ranking your poop, right?

[Dr. Tricia Pasricha]

Yeah. So this is a nice, easy way to look at what your stool looks like. Look at that shape and that consistency. And so the scale is from 1 to 7 with 4 being right in the middle. It's that like perfect smooth snake like stool that people dream of. And then above that, you have types one, two and three. And one on the extreme end of that spectrum is like these hard little rabbit pebbles. And if you're seeing that, it probably means that poop has been in your colon for the longest. And as you make your way down that scale from 2 to 3, it starts to become a little bit more formed, more bunched together. When you hit four, it's this like smooth sausage. And then five and six, it starts to get fluffier and fluffier. And by the time you hit the end of the scale, which is a type 7, it's just water. Most people actually do live in a, in America, live in a type 3 or 4 stage, which is like smooth sausage or maybe like a little, couple little cracks in that sausage.

[Regina Barber]

So what are, what are the things that people would see in, like, what are the changes that they should be, you know, cautious of?

[Dr. Tricia Pasricha]

Yeah, certainly anything that looks like blood, that is a literal red flag. Unless you've had beets, if you've had a beet salad, you'll get a pass for one maroon colored stool. But like, and even if you're like, no, I had it two days ago, it might be two, three days late. But then black, like tarry, sticky, black, shiny stool, that too could happen. If the blood mixes with the acid from your stomach, it can turn black. So those things are emergencies. Those are like, talk to your doctor,

[Regina Barber]

like red and black bad.

[Dr. Tricia Pasricha]

Yes. Pain and abdominal pain. It doesn't have to be 10 out of 10. I think my appendix has burst kind of pain. It can just be this, like, kind of low grade dull pain that's there and it wasn't there before. That should bring you in. And then anything that's like weight loss that you didn't intend, iron deficiency anemia. And then the most important one, which I tell people about is a change in your bowel habits. This means something has changed to your pattern. Maybe it's new diarrhea. Your stools are more loose than they used to be. Maybe they're suddenly more narrow and thin than they used to be. Any change for you, and this requires you looking every day, you have to know what's normal for you. Probably there will be some etiology that is perfectly reassuring, but you should at least just get someone to lay eyes on the situation.

[Regina Barber]

And there's other reasons why your poop could suddenly turn a different color. Right.

[Dr. Tricia Pasricha]

It's actually funny. I get this a lot from college students who like, start drinking for the first time in large quantities. But they'll often poop like purple when they come to college. But they'll have drunk like half a bottle of red wine the night before. And I'm like, you know what, first of all, we have to have a conversation about this. But also it's probably the anthocyanins that were in your red wine that gave you this, like, nice purplish, bluish poop the next day.

[Regina Barber]

I should have said this earlier for our listeners. You wrote a book all about this called you've been pooping all wrong. And you say in the book, yellow and green are also okay.

[Dr. Tricia Pasricha]

It depends. So if you were to say, I have this, like, new yellowish poop and I have diarrhea and I feel ill. I would say you need to go to the, maybe even the urgent care or the emergency room because maybe you have an infectious diarrhea. If you were to say my poop is a little yellow and I've been doing this keto diet for the last two, three weeks, then I might say, you know what, maybe that's okay. It's all that fat. Yeah, exactly. There's another color that is an emergency, which is white. White poop or grayish pale clay colored poop that is actually the natural color of our poop without bilirubin. Bilirubin is this digestive enzyme that we produce on our own. That's what gives it the brown color. The bile salts in this juice called bilirubin. But if you have a gallstone potentially, if you have a cancer potentially, or something else obstructing that bilirubin, your poop can turn white. So that is an emergency no matter what.

[Regina Barber]

In your book you said poop is stinky and farts are stinky, but there are a way to make them not stinky.

[Dr. Tricia Pasricha]

Yeah. This is like one of the biggest life hacks I feel like for people especially relevant on dates, like relevant when you're meeting the in laws for the first time, whatever the situation might be that you've deemed high risk, you can take Pepto Bismol beforehand. So it's the sulfur gas that gives farts their smell and bismut subsalicylate, which is the compound that is in Pepto Bismol that actually, really, really effectively binds those sulfur producing gases. And so you'll be able to kind of neutralize that sulfur. Now you probably shouldn't take it for days and days and days on end, especially if you're taking something like aspirin at the same time. But for just like a couple day trip like, or even just one night, totally safe to do.

[Regina Barber]

But your. But your poop will be black.

[Dr. Tricia Pasricha]

Yeah. Be forewarned that there will be a change, but hopefully not one that others will notice just looking at you.

[Regina Barber]

Okay, totally. So going back to the more serious situation, like the high amount of cancer in young people, why are more young people getting this kind of cancer nowadays?

[Dr. Tricia Pasricha]

Yeah, that's the question. One of the most common etiologies that a lot of the data is pointing towards is our diet. And it is specifically ultra processed foods. And it's probably a lot of different factors beyond that as well. But ultra processed foods do two things. One, they introduce these chemicals and Additives and high sugar and high salt that our microbiome doesn't love at all and can cause microscopic inflammation. And then the second thing is that ultra processed foods notoriously are low in fiber. Fiber is protective against colorectal cancer. And then I think what's really disturbing about that is that in these early onset cancer cases, particularly a lot of the studies point towards our diets when we're young, like in our adolescence and our teenage years, when we're eating ultra processed foods as young kids, when we're drinking these sugar sweetened beverages that's been shown to be linked. And so sometimes it's not necessarily like what you did in your 30s and then you get diagnosed at 37. A lot of the time it's stuff that has been brewing for a long time and in some cases well before you really even had conscious control over and the kind of, even the knowledge over what you were doing because it happened so early in life.

[Regina Barber]

Let's end on something that people can do for themselves to make themselves healthier, happier. What advice do you have for me for our listeners to poop better?

[Dr. Tricia Pasricha]

I mean, you know, the first thing I ask myself in a day, or at least the last thing I ask myself towards the end of the day is like, what have I done to feed my microbiome today? And I think if you think about that question, it'll change what you do over the course of the day. Because I've studied the gut brain connection now for more than a decade. And the enteric nervous system, that is this network of nerves that lives in your guts, has really made me view the gut as this brain. It's not just this set of plumbing and pipes. And I want people to think and treat their guts like this really delicate brain, which it is. And to think about their microbiome which is kind of running the show behind so much of your health as something that you, it is your responsibility to feed and nourish. And so for me, practically speaking, what that means is I try every day to meet my fiber goals. And I'm doing that because I'm thinking specifically about what are my microbes going to eat. If you don't give them fiber, they don't have anything to eat. And then two, I think about if I can I try to eat something fermented every day, like a probiotic food, like maybe that's Greek yogurt, maybe that's sauerkraut or kimchi, or in Indian cuisine we have dosas which are fermented, which are lovely, but something fermented also helps fuel the microbiome. And there have been very big studies on fermented foods will change those microbes in a really good way. So if I could do one thing, meet your fiber goals, like that's 1, 2 and 3, and then 4, toss in a little fermented food.

[Regina Barber]

I hope that our, you know, discussion helps other people talk about their poop. And I want to thank you so much.

[Dr. Tricia Pasricha]

I really appreciate you having me on thank you

[Regina Barber]

shirt waivers. If you found this episode to be helpful and fun, share it with a friend. Especially if that friend, like me, is due for their first colonoscopy. Sharing is caring. This episode was Produced by Burleigh McCoy and edited by our showrunner, Rebecca Ramirez. It was fact checked by Tyler Jones and the audio engineer was Anle Huang. I'm Regina Barber. Thank you for listening to Short Wave from npr.

[Dr. Tricia Pasricha]

My inbox, my medical inbox. I don't accept personal photos, okay, but my medical inbox is filled with pictures

[Emergency Room Advice Announcer]

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