Mucus in stool

On average, we poo 1.2 times in 24 hours, producing up to 128 grams of wet faeces a day. The mucus in poo comes from the mucous membrane that lines the digestive tract, especially the large intestine. It helps to move things along in the colon, so a little bit of yellow or clear mucus in poo is normal. But if you notice the following signs, it may be time to see a doctor:

• You can see more than the usual amount of mucus in your stool, in more than one bowel movement
• You have mucus in your faeces and the colour, consistency or frequency of your bowel movements has changed
• You have mucus in your poop as well as bloating, cramping and discomfort that does not go away even after passing wind or stools
• You have rectal discharge containing mucus but no poo comes out
• You have had diarrhoea or loose motions for two days (for babies under three years of age, one day, and for infants, 8 hours)
• You have bloody mucus in your faeces (read more: blood in stool)
• You have stomach pain along with mucus in your poo
• You are pregnant, you have had more than three loose stools in a day and there’s mucus or bloody mucus in your stools (note that a little extra mucus in the poo in early pregnancy is chalked up to normal changes in the body during pregnancy)
• Among infants, a bit of mucus in poop is normal. It is more commonly seen in breastfed babies as the food passes very quickly through their gastrointestinal tract. However, if the baby is irritable or fussy, has fever or diarrhoea along with mucus in stool, you should call their paediatrician for advice.

Normally, intestinal mucus plays an important role in lubricating the colon (large intestine). It also grants us immunity in the following ways:

• The mucus creates a barrier between the gut microbiome and the epithelial lining of the gut. The colon makes a thick inner layer of mucus for this purpose
• Mucus contains glycans that bacteria can feed on—on the one hand, it can sustain good bacteria. On the other hand, mucus can also trap bacteria, depending on what the body needs
• Mucus (especially in the small intestine) can do a sampling of the gut bacteria and communicate which bacteria are present back to the dendritic cells (an important part of the immune system that “presents” antigens to the immune cells so an appropriate immune response can be put up if needed)
• Inflammation in the gut can trigger localised production of mucus and fluids (by mechanisms such as activating the P2 receptors and increasing nitric oxide) which may help to flush out toxins and some bacteria. (Inflammation is part of the immune response, helped along, in this case, by pro-inflammatory cytokines known as interleukin-1 or IL-1.) (Read more: What is a cytokine storm?)

Of course, intestinal bacteria can sometimes overcome these defences by making enzymes that can break through the mucus. This may lead to infections and inflammation in the gut.

The amount of mucus made by the intestines can vary, depending on the person’s health. It is also regulated by “neurocrine, paracrine, endocrine and immune pathways” Here are some conditions that lead to increased production of mucus and excretion of mucus in stool:

• Dysentery and diarrhoea are among the most common causes of mucus in stool. Dysentery is an infection of the intestine (especially the large intestine, colon infection) and diarrhoea is defined as three or more loose or watery stools in a day. In both cases, mucus production in the intestines increases and this mucus can also pass into the stools.
• Irritable bowel disease, ulcerative colitis and Crohn’s disease are marked by inflammation which can trigger excess production of mucus in the intestine, and consequently in the faeces. IBD is also associated with gut spasms which push the food through the digestive tract too quickly, resulting in mucusy stools.
• Infections such as Clostridium difficile infection increase the production of a type of mucin (mucus) called MUC2. Research shows that the composition of intestinal mucus is also changed in people with C. diff infection, including C. diff infection induced by antibiotics. Both viral infections (example, stomach flu) and bacterial infections (example, pathogens that cause food poisoning) may show up as mucus in stools.
• Cystic fibrosis is a genetic condition in which the lungs, intestines, liver and reproductive tract make too much mucus. In people with this condition, this can sometimes cause mucus in stools
• Anal disorders like an anal fissure, anal abscess, anal fistula may cause mucus in stools. In the case of anal fistula, the mucus may be foul-smelling. An anal fissure is a tear in the rectum that may be caused by straining to poo or during diarrhoea. An anal abcess is an infected area near the anus. A fistula anywhere in the body is a serious health concern as it denotes an opening or tunnel where there shouldn’t be one. It makes people more prone to infections and other health problems. Mucus in stool can both be a result of an anal fistula, and a warning sign of a health issue—like an infection—arising from an anal fistula.
• Bowel obstruction may cause fluids and mucus to leak out as rectal discharge.
• Gut inflammation or infectious colitis can cause excess mucus production in the large intestine which may show up in the faeces
• Colorectal cancer has symptoms such as mucus in stool, cramps, nausea, feeling like there’s still some poo left inside after defecating 
• Other health conditions that may cause mucus in stool include constipation and dehydration

Keep in mind that mucus in stool is just one symptom that may or may not be linked to an underlying health issue that needs medical intervention. All of the above-mentioned conditions have other symptoms, too. So if you have mucus in your stool, there’s no need to panic. Visit your doctor for a proper diagnosis and treatment plan.

A doctor will begin by asking about your symptoms and taking your vitals like body temperature. In case you have a fever, it may point to an infection. In this case, the doctor may order a stool test or a blood test to check which pathogen is responsible. The doctor will conduct a physical exam.

If you have other gastrointestinal symptoms like cramps, stomach pain and bloating, it could point to gut inflammation—including gut inflammation due to irritable bowel syndrome or irritable bowel disease. In this case, too, the doctor may order some tests like stool culture test depending on your symptoms.

Rarely, your doctor may advise a colonoscopy, an endoscopy, a CT scan, a pelvic MRI scan or biopsy. If your doctor suspects cystic fibrosis, he/she may order a sweat electrolyte test.

In many instances, mucus in stool does not require treatment. It goes away with better diet, intake of lots of fluids and fibre. Regular exercise also helps to improve bowel function, so this too could help.

Where mucus in stool is a symptom of a health condition, treating the health condition will also improve mucus in stool. For example, if the mucus in stool is due to infection by campylobacter, salmonella or shigella bacteria, antibiotics may be prescribed.

Equally, if you have been taking antibiotics for any reason, this could cause an imbalance in your gut microflora. Ask your doctor if you should include probiotics like Bifidobacterium or Lactobacillus and prebiotics in your diet to improve gut microflora.

For viral infections like stomach flu, bed rest and lots of fluids may be what the doctor orders. Rarely, antivirals may be prescribed. Over the counter medicines to control the fever or body pain may be taken in some cases.

If you have a weak immune system, your doctor may advise precautions to avoid frequent infections and supplements to address nutritional deficiencies.

In cases where IBD is the cause of mucus in stool, lifestyle changes like following an anti-inflammatory diet and including more probiotics and fibre could help.

Anal fissures tend to heal on their own, provided the patient avoids certain habits like straining on the toilet or spending too much time in the loo. Anal abscesses, ulcers and fistulas would need medical intervention, including some surgical options for fistulas.

Colon cancer would require therapies such as chemotherapy, radiation therapy or cancer immunotherapy.