What Do Gallstones Look Like in poop & toilet?

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Gallstones can be seen in the toilet either as separate stones or embedded near the surface of the stool. The most common type is cholesterol gallstones which appear as a yellowish small stones that may float on the toilet water.

However, gallstones come in different shapes, sizes, and colors. Today, you will learn the common types of gallstones, how they look in the toilet, and the associated symptoms.

How do gallstones reach the colon & the stool?

Your gallbladder is a sac-like structure attached to the liver. The gallbladder act as a storage site for bile in-between meal.

When you eat, the gallbladder empties its contents (the bile) into the small intestine.

Bile passes from the gallbladder through a series of ducts (the cystic duct and the common bile duct).

The gallstones reach the stool in one of two ways:

A. The usual way:

A small stone (often less than 1cm in diameter) manages to escape the gallbladder throughout the cystic duct to the common bile duct. It finally reaches the duodenum,

From the duodenum, it passes down throughout the digestive tract (the small intestine and the colon) to be expelled with the stool.

Stones passing through this way are often small in size. As a result, the gallstones may block the common bile duct and/or the pancreatic duct during their passage.

This will result in severe complications such as severe biliary colics, obstructive jaundice, or acute gallstones pancreatitis.

B. Biliary enteric fistulas:

Previous attacks of acute cholecystitis may cause a fistula (tract) between the gallbladder and the intestine (called the biliary-enteric fistula).

This is not a rare complication. For example, studies estimate that 2-3% of the cases of acute cholecystitis lead to biliary-enteric fistula).

Unlike, a fistulous tract is often wide and allows for the passage of larger stones.

Also, the passage of these stones may be entirely asymptomatic, but very large stones can obstruct the narrow part of your small intestine (the ileum).

Is it common to see gallstones in the toilet?

Passage of gallstones in the stool is not a common complaint. However, we found we couldn’t find studies assessing the exact incidence.

Also, you should know that you won’t notice all the gallstones that pass in the stool.

Most of the gallstones in the stool pass unnoticed. Three reasons why most people don’t notice gallstones in the toilet:

  • The gallstones are often dark in the colon and buried in the stool (they are rarely passed separately).
  • They cause no pain or any other symptom during their passage.
  • Most gallstones reaching the stool are small (often less than 1 cm in diameter).

What do gallstones look like in the toilet?

A. Cholesterol gallstones.

  • Frequency: It is the most common type of gallstone (in about 80% of the cases).

  • Common in America and northern Europe.

  • Composition: mainly from cholesterol (some are cholesterol, others are mixed with bile and calcium).

  • Causes: conditions that lead to increased cholesterol secretion in bile, such as:
    – Rapid weight loss.
    – Obesity.
    – Estrogen Treatments (as OCPs).
    – Multiple pregnancies.

  • How they appear in the toilet:
    – Size: small (less than 1 cm in diameter, rarely larger).
    – Shape: round, oval, or faceted.
    – Color: Yellow (often pale yellow).
    – Consistency: Firm to hard.

B. Black pigment gallstones.

  • Frequency: Most common type in Asians, less common in the USA (about 20%).

  • Common in Asia.

  • Composition: calcium bilirubinate phosphate carbonate.

  • Causes: due to elevated levels of unconjugated bilirubin. As with:
    – Blood breakdown (hemolysis and hemolytic anemias).
    – Alcoholism.
    – Liver cirrhosis.
    – Pancreatitis.
    – Crohn’s disease.

  • How they appear in the toilet:
    – Size: often very small (2-5mm).
    – Shape: Ovoid or irregular, with a shiny outer surface.
    – Color: Jet black.
    – Consistency: Hard, difficult to crush.

C. Brown pigment gallstones.

  • Frequency: least common of the three types.

  • Common in Asia.

  • Composition: calcium salts, fatty acid products, bacterial degradation, unconjugated bilirubin, and precipitated cholesterol.

  • Causes: often due to biliary infection (bacteria and parasites).

  • How they appear in the toilet:
    – Size: often large.
    – Shape: oval or irregular.
    – Color: brown or brownish-yellow.
    – Consistency: soft.

Do gallstones float in the toilet?

There are not much scientific data about the density of gallstones and whether they float on water or not.

Gallstones may or may not float on the toilet water, depending on their type and composition. For example, the cholesterol gallstones may sometimes float, while calcium gallstones often sink.

Some studies suggest that gallstones that float are the cholesterol type rather than the non-cholesterol type (reference). But these studies studied the floating of gallstones in bile (inside the gallbladder, by imaging), not toilet water.

What are the associated symptoms of gallstones in the toilet?

The gallstones usually pass through the biliary duct to the intestine and the stool.

When reaching the stool, there will be almost no symptoms. Symptoms of gallstones passage often proceed with their appearance in the toilet.

These symptoms are often caused by the passage of the stone through the bile duct causing temporary obstruction of the bile duct or the pancreatic duct.

Symptoms preceding the passage of gallstones in stool include one or more of the following:

A. Typical biliary pain.

  • Sudden onset severe dull aching pain in the right upper abdomen radiates to the right shoulder, back, and the epigastric area.
  • The pain comes and goes in attacks. Each episode lasts at least 30 minutes and may last more than 6 hours.
  • The pain is associated with severe nausea and vomiting.
  • When the gallstone passes into the duodenum, the pain usually resolves.

B. Symptoms of bile duct obstruction (obstructive jaundice & cholangitis).

Besides biliary pain, the gallstone may block the common bile duct with subsequent blockage of the bile outflow from your body.

This trapped gallstone in the bile duct produces severe biliary pain as described above plus:

  • Jaundice (yellow eye whites and skin). Jaundice often rapidly progresses if the blockage is not treated.
  • Dark (tea-colored) urine (due to excess bile in urine).
  • Whitish (clay-colored) stool (due to lack of bile in the stool).
  • Fever may occur (due to infection of the stagnant bile; A Condition called acute cholangitis).

C. Symptoms of pancreatic duct obstruction (acute pancreatitis).

Sometimes, the stone slips into the pancreatic duct (which joins the common bile duct just before its end), leading to its obstruction.

Obstruction of the pancreatic duct leads to blockages of the digestive pancreatic secretion.

As a result, the pancreas undergoes serious inflammation, a condition called acute pancreatitis.

Symptoms of acute pancreatitis due to gallstones include:

  • Typical pancreatic pain, acute onset, persistent and severe pain in the central upper abdomen (epigastric area).
  • The pain often radiates to the center of the back and sometimes to the left shoulder.
  • Unlike biliary pain, pancreatic pain is often persistent for days (it doesn’t come and go in attacks).
  • Both biliary pain and pancreatic pain may coexist in this type of patient.
  • Anorexia, nausea, and vomiting are common.
  • Fever.
  • In severe cases, pancreatitis may lead to complications such as intraabdominal hemorrhage and septicemia.

All the above symptoms often resolve with the passage of the stone (except for pancreatitis symptoms that may become persistent for days or a week).

The passage of the stone into the toilet can also be entirely asymptomatic.