Things You're Too Embarrassed to Ask a Doctor Season 1, Episode 6: Pediatric GI with Dr. Ritu Verma

[MUSIC PLAYING] You're listening to Things You're Too Embarrassed to Ask a Doctor, a production of UChicago Medicine. Each week, we'll feature one physician and ask them your most searched questions in their areas of expertise. For more information on our episodes, visit us at www.uchicagomedicine.org/podcast. Have something you're too afraid to ask your doctor? Tweet us at @tytepodcast. I'm your host Kat Carlton.

Hey again. If you tuned into last week's show, you might remember some useful information on determining whether or not something you see before flushing the toilet calls for a visit with the doctor. If you thought I was done with the bathroom talk, sorry, think again. This episode is meant to be especially useful for anyone who takes care of children, or anyone who's been changing a diaper and wondered, is this what it's supposed to look like? Today we're joined by pediatric gastroenterologist Ritu Verma, who will answer questions about poop--

And we all should feel free to say poop.

--and a whole lot more. Let's turn to Dr. Verma for a refresher on what exactly gastroenterologists do.

Gastroenterologists will say that they not only take care of the intestinal tract, but we also take care of the liver, the gallbladder, the pancreas. So it's a whole bunch of organs that are taken care of by a doctor like me.

Our first question has to do with poop and its color, which is one that's searched very often. So Dr. Verma, do I need to take my child to the doctor if their poop is green?

So not necessarily. And I think with poop-- and we all should feel free to say poop. I know we have many names for that. But I think it's more important in terms of how long this green poop has been there. For how many days, and so on. So green by itself, the answer is no. You don't need to be as worried.

But you do need to know, how often is the poop green? What's the consistency? What does the poop look like? Is it loose? Is it hard? And what did I eat, or what did I drink is probably the most important thing whenever it comes to color of poop.

So what about other colors? Are there any that signify that something's going on that's wrong?

So we always, as a gastroenterologist, get concerned if the poop is really black and dark. But not just black and dark, but more like a tarry, sticky kind of stool. If someone sees that, it's something that's concerning. If there is obviously red blood, it's concerning. Not necessarily an emergency, because again, then it depends on what does the poop look like? If you're having a really hard poop, and there's red on it, it's not an emergency. It's something that we need to address, but it's not an emergency.

But if it's red and it's all loose diarrhea, again, not emergency, but more urgent than the previous one where the stool was more formed. And then we also get concerned if it's like a clay-colored stool. If it's clay-ish, then we get concerned about that as well.

Again, none of them are emergencies except for that real red blood coming out, or the dark tarry stools. But something that you should bring the attention to your doctor.

So if the stools are that black tar that you mentioned, what does that mean? What causes that?

So often, the first thing that pops into everyone's mind is there must be blood there. But let's not panic. Let's also talk about what medicine someone is taking. So if someone is on iron, the stool will be black. Not necessarily tarry, but it will be black. If someone is taking Pepto Bismol or something like that, it can be black as well. But usually, black, tarry, the first thing we want to be sure that we rule out is if it's blood or not, but take a history in terms of what medicines did I take recently.

Moving on from colors, what do the different smells of poop signify? What does that mean?

You know, for a gastroenterologist, poop doesn't smell. We have the special noses. But if the poop is smelling really foul, foul smelling, not just a regular-- really foul smelling, and the poop is kind of loose, then you're concerned a little bit about infections. Sometimes, though, some children can be extremely constipated and have this really foul smelling ooze that comes out. And that's called encoprises, where you're having an overflow. Now there's too much poop in the colon, so it's oozing out.

So real foul-smelling loose stools, you're concerned about infections. It's something called C. difficile that you're concerned about. Any person who has had C. difficile clearly knows the smell.

The next question might be a little nebulous. It's, which type of poop is dangerous?

So I don't think that poop is ever dangerous unless it doesn't come out. So then, even then, it's not dangerous. It's concerning. So I think there are-- if there's that black tarry stool we talked about, if there is the clay-colored stool, we're concerned. It's definitely something that you want to address with your physician pretty quickly. You don't want to wait two weeks or something like that. You want to have that addressed. Those are concerning stools.

Dangerous happens down the line if someone has a condition-- something like Crohn's disease, and you're concerned about certain kinds of stools. But I don't think stool is ever dangerous, is the nice thing.

What should my child's poop look like?

So there are many ways of looking at stool. I usually will tell my patients, something like a toothpaste consistency of the stool. So if you imagine one of those toothpaste things and you're squeezing out, that's sort of the consistency you want.

There are many things out on Dr. Google that you could look at. There's something called the Bristol stool chart. A lot of people look at it. And actually, I think is one of the nicest things that we have as a tool so parents don't have to then say, oh, it looks a little bit hard, a little bit soft. If you just look at that Bristol stool chart-- and everyone can download it, if they haven't already downloaded it-- and there's the type 4, that's the perfect. Now, we don't always have perfect stools. So some days, it's 5, some days, it's 3. That's OK, but the type 4 is the perfect stool.

What should parents feed their children so that their poop stays regular and at that ideal level?

So the most important thing is the fiber. So it's really important that children eat lots of fruits and vegetables. And again, many children who don't like to eat fruits and vegetables. And I think we need to encourage them. If we make it a mandatory thing-- we all know that if we tell our children it's mandatory, it's never going to happen. So I think camouflaging some of the fruits and vegetables in the diet is important. But things like beans, if you can incorporate some black beans. So some camouflage. There are lots of recipes out there. Even making brownies with black beans-- I don't know how they taste, but-- so fiber is important.

Besides fiber, it's really important that children drink water. Not juice, but water is the key to that. And the third key-- and I'll give you a fourth one as well-- the third key is making sure that they're very active. The child who's just sitting there in front of that video game and not moving is probably not going to be moving his colon that much either, or her colon.

And then the fourth thing is to find the time to sit on the toilet. We have so many activities for our children. They are in school the whole day, and then we take them off for musical lessons, and this, that, and the other. So they really don't even have time to sit on the toilet.

So one of the things that I would encourage every parent is that at the end of the day, the child sits on the toilet without a video game or some accessory in their hand. They sit on the toilet, make sure their feet are flat on the ground. That posture is so important to have a good bowel movement. Even if the child says, oh, I had a bowel movement at school or whatever, have them sit on the toilet at the end of the day. And usually, it's a minute for every year of your life till you're 10, and then after that, it's 10 minutes.

So just to summarize, the fiber, the water, the exercise, and daily toilet sitting, regardless of the fact whether the child wants to go or not. We need to find the time for our children to sit on the toilet and actually poop.

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At what point should a parent take their child to the doctor if they've been having diarrhea?

So there's no hard and fast rule that it has to be these many number of stools that bring you to a doctor. You have to look at what the child's normal pattern is. And if the diarrhea is on a regular basis every single day for a few days, I would at least pick up the phone and talk to the doctor or the nurse. But I would also do a little homework at home and see, is there anyone else who's ill? Find out if there's anyone at school who's ill. And see, what did I change in this child's diet?

But even if I drink a cup of milk every day, but suddenly now it's summertime, so the child is having more ice cream and more milk, so it could be lactose intolerance. So figuring that out a little bit would be a good thing. Now, if it's diarrhea, the child is not able to hold it in or anything, obviously call the same day.

Any last thoughts on diarrhea?

[CHUCKLES]

I think diarrhea is something that we shouldn't ignore, and also something that we should not panic about right at the first loose stool.

Good to know. Switching gears, let's talk about vomiting. So at what point should a child see a doctor for vomiting?

Again, going back to, if it's one episode and then the child is fine, then maybe not. But it's vomiting where you're not able to keep anything down, vomiting many times in a day, absolutely pick up the phone, talk to the doctor.

Can vomiting kill you?

Anything can kill us. We walk outside, it could kill us. Depends on what the vomiting is from. So for example, let's say if someone has a twist in the intestine, and they continue to vomit, vomit, vomit, that twist itself can be a problem, and hence, at some point, could lead to death, but usually not. But again, I think we have to keep it in perspective. Stay calm. There's too many episodes of vomiting the same day, child is not able to keep much down, pick up the phone.

When you say twist in the intestine, do you mean like the intestine is physically kind of kinked?

Yeah. So there's something called mild rotation. Children can be born with that. And it's something where the intestine twists on itself, and it can cause a kink, and that can cause vomiting as well. So can that kill you if you ignore it? I guess yes. But I really don't want people to be out there alarmed that, oh my god, there's vomiting. It must be the kink, and this is going to happen.

I think, again, caution. You're concerned, always pick up the phone. I think it's one of those things, as a parent, you never want to be in a situation thinking in your mind, should I, should I not, should I, should I not. Much easier to pick up the phone, talk to the nurse in the office, either be reassured, or move to the next step. But at the same time, not to be panicking with every moment of vomit.

What should parents be feeding their children if they're experiencing vomiting?

So usually with vomiting, the children really don't want to eat anything, or drink anything. So I wouldn't force them. However, even if it's like a teaspoon, or a tablespoon of some fluid, if you just have them drink that in between those, that's enough to keep them hydrated. Often, children will like something like Cheerios, or a cracker, or something. That's what I would do. I wouldn't try and force them a meal. I would just say small amounts throughout the course of the day. So it could be as simple as a teaspoon every few minutes of some fluid that you're drinking, and something dry and salty.

Can parents give their children medication if they're vomiting, maybe either medication to help stop the vomiting, or maybe other medications they're on in general?

If you're on a medicine in general for certain things, it's very, very important that you know, if you skip that medicine, is that going to cause a problem? So for example, if you're on a medicine for high blood pressure, or if you're on a medicine for diabetes, or something, you don't take the medicine, you'll be in trouble, right? So it's important to know how critical that medicine is to take it at that time.

Unfortunately, if a child is throwing up and you give the medicine, the child's going to throw up. So if there are a number of medicines the child is on, chronic medications for other conditions, pick up the phone again, and talk to the doctor's office, and ask them how critical is it. And if you give that medicine and the child throws up, you want to call again and say, should I repeat the dose of the medicine?

As far as giving medicines for vomiting, I would not recommend that. I think you really want to figure out why is the child throwing up before you give any medicines.

What if someone's child is vomiting but doesn't have a fever. What does that mean?

So the vomiting can still be from an infection. There are certain infections that you don't get fevers for. But it could be something you ate, could still be infection. If someone has really like a bad sinus infection, or a cold, or allergies, and is swallowing a lot of mucus, that will also make them nauseous, they'll throw up. Is it a medicine that I took? So having the fever only tells you that there might be an infection or inflammation. Not having the fever doesn't really help you much.

Are there any instances where parents should induce vomiting in their child? Say if maybe they ate something that was poisonous?

It depends on what you ate that was poisonous. There are certain things that you actually don't want to induce. So if you think your child has had some poisonous thing, call poison control, because there are certain poisons that if you actually induce the vomiting, you're going to cause more problem. So do not induce vomiting if you are not sure what's going on. It's different if you think the child is choking and you're doing something, but absolutely not. Do not induce.

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Moving on to tummy aches. This is a really common one. When does a tummy ache warrant a doctor's visit?

So tummy aches are probably one of the most common visits for us in GI as well. So what warrants a doctor's appointment? So I think if a child is having-- a child doesn't usually have pain, and then starts pain, and there doesn't seem to be an obvious reason, you should definitely take to the doctor.

Pain that is present in specific spots-- so for example, on the right lower side-- you want to think about appendix and so on, and other inflammatory conditions. If your pain is in the right upper, you think gallbladder. So depending on where the pain is as well, it's helpful. But if it's pain that is every single day, or many times a day for several days, absolutely, the doctor.

What are some of the most common causes of stomach pain in kids?

The most common cause for stomach pain is constipation in children. Then you have things like acid reflux, but constipation is really the most common cause for abdominal pain in children. So get a history. When was the last time your child actually pooped, and you'll be surprised what the teenager tells you.

But acid reflux is something that is seen in children as well. Often, parents get very surprised when we tell them their child has acid reflux, because everyone thinks acid reflux is like an older person's disease. But constipation, reflux, irritable bowel. Gallbladder can be there, not necessarily all the time, but Crohn's disease, celiac disease are all conditions that can give you abdominal pain as well.

So you mentioned teenagers. Do teenagers often conceal the fact that they're constipated or having bowel issues?

The teens never want to talk about poop. They're so embarrassed. And some of it is what we as a society do is we don't talk about poop. We say number two, we say BM, we say all sorts of things. So we have stigmatized poop as well. It's so funny, in our home, poop is talked about very freely at the dinner table. And I think it really should be talked about freely at the dinner table. Maybe not in the church or the synagogue, but at the dinner table, I think it's fine.

But teenagers don't want to talk about poop till you actually start talking about it, and then you'll see them going to town, especially the boys. And if you show them the Bristol stool chart, they love it. Definitely, you could bring out the Bristol stool chart as a conversation piece with your teen if you can get them just to show you the kind of poop it is, that's enough.

Well, thanks, Dr. Verma. We've gotten through all of our questions today. Is there anything else that you want listeners to know? I know before you mentioned that we should talk about poop more freely, for example.

I think it's very important to be open with our children as we talk about it. Not to shy away, not to walk away to another room if you're going to talk about diarrhea or anything. So very important-- about everything in life, but very important to be open about this so your children will actually come and talk to you about that.

The second thing I would say is, don't blow off the symptoms that your children are telling you about, but at the same time, don't over-talk about those either, because then you're putting things in the child's mind as well, and then that itself will give us more symptoms.

Very important that if a child comes up with you with a symptom, then sit down calmly and think about, OK, what changes happened in our life? Was there a grandparent who was very ill? Did something like that precipitate? It can precipitate any one of these conditions. Any one of the conditions we talked about.

So sit down, think about that. What changes did I make in the diet? What changes did we make in lifestyle? What medications? Have all that with you, and then go make an appointment with the doctor.

Wonderful. Thanks so much, Dr. Verma, for being on our show today.

My pleasure. Thank you.

Once again, I'm Kat Carlton, and you've been listening to Things You're Too Embarrassed to Ask a Doctor. Music from today's episode is by Blue Dot Sessions. For more information on our show, or to submit your own question, visit www.uchicagomedicine.org/podcast, or tweet us at @tytepodcast.

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