Stools

Question

What is so different in the stools of toddlers with CF. I know that the stool is greasy, but what about the colour? And are there many undigested particles in it ?

Answer

Thank you for your question. The normal aspect of the stool of a toddler is variable and depends on what the child eats. Solid stools every two days can be as normal as soft stools three times a day. The colour of the stool can vary from light brown , yellow-green to dark brown without this meaning that there is any symptomatic disease. Some vegetables such as corn, tomato or mushrooms can be incompletely digested and will appear recognizably in the stools.
Most toddlers with CF (± 85%) have insufficient production of pancreatic enzymes so that mainly fat and protein are incompletely digested. The fats that aren’t absorbed appear in the stools so that these look shiny, rather pale and float in the toilet. The undigested proteins will be transformed by bacteria in the intestine to foul smelling products (think of rotten eggs or fish). The total amount of stools is bigger and belly cramps frequently occur. Apart from this cosmetic effect on the stool the bad digestion will lead to insufficient uptake of fat and protein and poor nutritional state.
Thanks to treatment with pancreactic enzymes, in capsules that are taken by mouth together with the meals, the digestion of fat and protein is much improved and the body will take up these fats a lot better. If the capsules with pancreatic enzymes are taken with every meal, the discomfort of bad digestion will also go away or at least be much improved. Toddlers with CF who are not treated appropriately will thus have frequent and voluminous stools with a bad odour. The colour is usually light yellow to grayish, sometimes with orange fat droplets. The aspects of the stool will not always be that pronounced in CF patients and certainly not always quickly lead to the diagnosis but together with a poor weight gain these alarm signs should lead to the diagnosis of Cystic Fibrosis.
Apart from CF there are other causes of persistent diarrhoea in children. “Toddlers’ diarrhoea” is f.i. much more frequent. Here the stools have a variable consistency (sometimes hard, sometimes soft and profuse), often with undigested food particles such as you describe in your question. The weight evolution will be normal and also the appetite. Toddlers’ diarrhoea is often worsened by a low fat diet.
Another frequent cause of bad digestion is lactose intolerance because of lactase deficiency. Here eating lactose containing foods (mainly milk) will lead to watery acid diarrhoea with production of gasses and cramps. Also here the weight evolution will be normal.
Of course, you can discuss your concerns about your child with your doctor.
F. Vermeulen

13.07.2009