Hard and Soft Stool Mixed Together? Here are the Likely Reasons.

By - Samin Ishmam

We all know that poops tell a lot about health. If your poop is abnormal, then it can naturally cause some worry.

Normally, you’d expect the stool to be either hard or soft. But, what if you see both of these at the same time? 

What does this hard and soft stool mixed point to and what can be the possible causes?

Hard and soft stool mixed occurs most commonly due to a gastrointestinal tract disease called irritable bowel syndrome or IBS. This is a condition of the intestines where there can be alternating diarrhea and constipation. Some other conditions can cause hard and soft poop together rarely.

Continue reading this article to know more about this condition. 

Hard and Soft Stool Mixed

Irritable bowel syndrome is the most likely reason to give you hard and soft stool mixed. This type of stool is most often called mixed consistency stool.

Irritable bowel syndrome can manifest as changes in your bowel habit. In most other diseases and conditions, there’s either diarrhea or constipation. However, in irritable bowel syndrome, the intestines react in such a way that you can have both diarrhea and constipation. 

And that’s what leads to the hard and soft stool mixed.

To better understand this condition, let’s dig deeper into Irritable bowel syndrome.

Irritable Bowel Syndrome

Irritable bowel syndrome is a chronic disorder that affects the intestines. It is classified as a functional disorder of the gastrointestinal tract. This means that there are no structural or anatomical problems in the intestines. Rather, the function of the intestines is hampered.

How Common is This?

This disorder is very common. It affects almost 10-15% of the population. And the incidence is more so in developed countries. However, only around 10% of the affected patients actually come to see a doctor because of this disease.

Women are more susceptible to IBS when compared to men. In fact, the risk is two times higher. And it occurs mainly before the age of 20.

How Does This Disease Affect the Body?

The exact mechanism by which this disease occurs is not known as of yet. There has been a lot of research though on Irritable bowel syndrome (IBS). However, scientists still haven’t found any concrete evidence on how IBS causes its symptoms on the body.

As you’ve already read, this is just a functional gastrointestinal (GI) tract disease. There are even no histological abnormalities in this condition. This means that even under a microscope, nothing abnormal can be seen. All the cells and tissues look normal.

There have been many theories regarding how this disease occurs. Some data suggest that there are abnormalities in the brain-gut axis. The brain-gut axis is the way the brain communicates with the gut. This is mainly done through the help of nerves and hormones.

The way the brain-gut axis works is quite complex. And many factors can influence this axis. Scientists think that IBS occurs when these factors disrupt the normal brain-gut axis. Some of these are:

Psychological Factors

IBS is associated with many psychological conditions. Anxiety disorder, depression, chronic fatigue syndrome, stress, history of abuse, etc. are seen frequently among those suffering from IBS.

These disorders can bring about a change in the brain-gut axis. Stress can increase the secretion of various chemicals and hormones. And these can act upon the nervous system of the gut and change bowel motility and the nervous system of the bowel.

However, it’s important to note that these disorders contribute to IBS, but they don’t directly cause IBS.

Physiological Factors

There are some of the physiologic changes in the body which are often associated with Irritable Bowel Syndrome (IBS). One such change is the release of the neurotransmitter 5-Hydroxytryptamine or serotonin (5-HT). 

In some IBS patients, too much or too little serotonin is released. This can alter gut motility because the gut responds to serotonin. An excessive release can cause diarrhea. And vice versa, less release of serotonin can cause constipation.

Some studies suggest that IBS can be related to low-grade immune activation or inflammation. However, these changes are so subtle that we still can’t detect them.

Factors Inside the Gut Lumen

Gut flora is an important part of the normal human GI tract. These are mainly bacteria that are normal residents of the gut which help you in many different ways. But these have to be in normal amounts.

Changes in the normal flora are associated with irritable bowel syndrome. Bacterial overgrowth can sometimes lead to the symptoms of IBS. Abnormal bacteria of the altered flora can be recognized by the immune system. And this immune activation can lead to IBS.

Another important luminal factor is diet. Some people have intolerance to certain types of foods. Intake of these foods can lead to the symptoms of IBS. However, this is different from an allergy. Intolerance can be to foods like certain short-chain carbohydrates, benzoates, silicates, etc.

IBS is also related to infection. In fact, 10% of IBS happens among people who recently suffered a bout of gastroenteritis. Infection with Campylobacter or Salmonella species often triggers IBS. It is assumed that autoimmunity might develop after some infections. 

This can lead to immune activation and subsequent IBS.

Clinical Features

IBS, as the name suggests, is a syndrome. And a syndrome is in fact a collection of symptoms. The main symptoms which you may experience if you have IBS are:

• Abdominal pain: This will be a chronic recurrent pain in your abdomen. The most common location is the lower abdomen. You’ll feel your abdomen cramping up. And this pain will go away after you poop.

• Bloating: Abdominal bloating and distension are other symptoms of IBS. You might even feel that the bloating will get worse throughout the day.

• Changes in bowel habit: IBS is a disease that can cause both constipation and diarrhea simultaneously. 

So, this is the likely cause of hard and soft stool mixed together. You might have a soft diarrhea-predominant stool on some days. And on the other days, hard stool due to constipation might be seen.

What Steps Should You Take if You Suspect You Have These Symptoms?

It’s best to go see your doctor if you had these problems. They can accurately diagnose your condition and give you the necessary treatments.

Below are some of the things that you can try that may help:

Be stress-free

As you’ve already read, the state of the mind has an impact on IBS. Stress and anxiety can actually make the symptoms of IBS a lot worse than they already are. And this can quite easily transform into a vicious cycle. So, it’s important to be reassured and to keep yourself stress-free.

Changes in diet

Many patients suffering from IBS benefit from dietary changes. You can try excluding wheat, lactose, or other irritants from your diet. If you drink too much coffee or artificial sweeteners, then you can try to reduce those as much as possible.

You also can also consider making a meal routine and eating at regular intervals. Reducing alcohol intake and smoking too can benefit in many cases.

Probiotics

You’ve already read that changes in gut flora can cause IBS. And that’s where probiotics can help. Probiotics can help bring balance to your gut flora. So, probiotics can be helpful in this case.

Exercise

Working out is a great way to reduce stress. Also, exercising regularly has a number of beneficial effects on the physiology of the body. 

Research has shown that mild exercise may also have an anti-inflammatory effect on the human body. All of these help in IBS as well as a number of other problems.

Herbal remedies

Some herbal remedies may reduce the symptoms of IBS. Some of them are peppermint oil, Iberogast, ginger, aloe vera, etc.

How Doctors Diagnose It?

Doctors can’t use many lab investigations to diagnose IBS. As you’ve read, there are no significant changes under microscopy or endoscopy.

So, the diagnosis of IBS is done clinically. Hence it’s important that you correctly tell your doctor about your symptoms. Because the diagnosis depends on the symptom.

Doctors can now easily diagnose IBS using the Rome criteria. These criteria have been revised a few times and now the most updated ones are used.

According to these criteria for the diagnosis of IBS, abdominal pain has to be present at least once a day every week for the past three months. 

Along with that, two or more of the followings have to be met:

Many other gastrointestinal diseases may present with these symptoms. So, necessary tests have to be done to rule those out, like sigmoidoscopy, CBC, endoscopy, etc.

How Do Doctors Treat IBS?

Doctors can have various approaches when it comes to IBS. The first line of therapy is reassurance. Positive reassurance can decrease stress levels. This is effective for most people.

Dietary control is the next thing that the doctors do. There are several dietary measures especially for IBS like the low-FODMAP diet, gluten-free diet, which a dietitian can prescribe.

In severe cases, doctors also use some drugs. These are various different classes of drugs that may be effective in some, but not in others. 

Some of these are:

Other Causes of Hard and Soft Stool Mixed

Although IBS is by far the most common cause of hard and soft stool mixed, in rare instances, there can be other causes as well.

Fecal impaction can lead to hard and soft stool mixed as well. This happens in case of severe constipation. Here, the stool is so hard and big that it can’t pass through the intestines. Parts of it may break and pass with the stool.

Soft and watery stools can sometimes leak from the sides of the impacted stool. This can give the appearance of soft and hard stool mixed.

Hard and soft stool mixed in children and toddler happens due to this reason. The child may soil their clothes and it’s called encopresis.

FAQs

Why is my poop hard and soft?

Answer: Hard and soft poop can be due to mixed type of IBS. Another condition called fecal impaction can lead to hard and soft stool as well.

What is IBS poop like?

Answer: IBS poop can be hard or soft or both at the same time. In the case of constipation-dominant IBS, the poop is hard pellety. In the case of diarrhea-dominant IBS, the poop is soft and may even be liquid with mucous.

Can I have diarrhea and constipation at the same time?

Answer: Yes, you may have diarrhea and constipation at the same time. Although this isn’t very common, it does happen sometimes. And the most common culprit is Irritable Bowel Syndrome (IBS).

Conclusion

Hard and soft stool mixed might scare you at first. However, it is not very uncommon. It happens most commonly with IBS. And IBS is a common disorder that is manageable in most cases.