Faeces And Your Health

By Francis Ewherido

November 19 was World Toilet Day. Of an estimated 673 million people worldwide, who still practice open defecation, about 47 million of them are in Nigeria! Tragically, this makes Nigeria the number one country with the highest number of people who practice open defecation. In terms of Percentage, however, countries like Chad, Benin and Ethiopia are way ahead of us in this aberration.

We are number one because of our large population. But that is nothing to celebrate. To start with, we no be mates with those countries. Secondly, India, which relinquished the number one position for us (in 2014, about 530 million Indians practiced open defecation), has virtually eliminated open defecation and the feat was achieved in less than six years. I remember seeing faeces (stool) on the streets of Chennai and Mumbai just seven to eight years ago.

But according to reports, India launched an ambitious plan called Swachh Bharat Abhiyan (Clean India Mission) in 2014 – that is a year after my last visit. The plan was expected to cost over ₹620 billion (US$9.0 billion) with the goal of ending open defecation within five years.

The Indian Prime Minister, Narendra Modi, recently declared that India is free of open defecation. He claimed that 600 million Indians were given access to toilets while 110 million toilets were built.  Impressive. Unbelievable. The rest of the world, including Nigeria, which are still plagued with open defecation, can only look at these staggering statistics in awe.

But India did not achieve this feat by magic. They achieved Swachh Bharat Abhiyan with heavy funding and single-mindedness. This is also possible here. It is just that it is not a priority yet. Last year, President Muhammadu Buhari signed Executive Order 009 to make Nigeria open defecation free by 2025. What is the journey so far? I am not sure. I have written severally about open defecation. Last year, I wrote: “The late Vice Admiral Mike Akhigbe was the military governor of Lagos when I first arrived in 1987. Thirty two years later and after a succession of military and civilian governors, nothing has changed as far as open defecation is concerned in Lagos State. Take the stretch before you ascend Carter Bridge when coming from Ikoyi. The median between the roads was a giant toilet when I first arrived in Lagos. Today (last Tuesday), when I passed through there, the act was still very much on. I saw four young men openly defecating at about 1:10pm.” Nothing has changed along that stretch as at two weeks when I took that route. But if India can give 600 people access to toilet, Nigeria can do same to 47 million people.

Anyway, while thinking about the problem of open defecation in Nigeria, I remembered an incident two years ago. I went for our professional association annual get-together. Apart from the core professional presentations, one resource person was designated to give a health talk. You know one way to grab the attention of people, who are 50 years and above, is raising health-related issues. We were all listening to the health talk with rapt attention until the resource person said that your poo (stool) is not supposed to have a smell and if your poo smells, you have a health challenge. The departure from the venue after her assertion was akin to what happened in the bible, after Jesus challenged the traducers of an adulterous woman to cast the first stone, if they were without sin (John 8:3-9). The only difference was that our departure was not chronological. The hall was empty in just a couple of minutes.

I could imagine what was going on in the minds of some delegates as they departed. There are some Nigerian delicacies that are so delicious, but with foul-smelling human waste (poo) How do you tell people who eat those delicacies that they have health challenges because of their smelly poo? In school, we had a student, who always ate soured food, especially beans. His farts were like earthquake. I would attribute the foul smell of his farts to soured food rather than a health condition. Over 30 years ago, I had a female colleague. Any time she went into the toilet, the smell that came out was terrible. Those of us in the open office suffered grievously. My MD never knew about our agony because he was always ensconced in his air-conditioned office, far from the maddening smell. That was until a certain day when NEPA struck (power outage) and he had to leave his office door open.

The lady went into the toilet. Within a few minutes, our ordeal started. Soon my MD came out from his office sniffing the air. “What is this?” He kept asking. We assured him that no one was evacuating human waste from a soakaway pit in the neighbourhood; that the source was our colleague. Thereafter, we got air fresheners, but her poo smell overpowered the fragrance of the air fresheners. I cannot recall who left the company first between the lady and I, but that was when my ordeal ended. Could her smelly poo be medically related? It is a strong possibility.

Anyway, let us hear from the experts. “A bowel movement doesn’t smell good and it doesn’t have to. Poop consists of undigested food, mucus, bacteria, dead cells and fiber. This combination just doesn’t smell very good. Plus, you have trillions of microorganisms living in your gut that produce sulfuric compounds, and those pass along with the feces to give poop its yucky smell.”

But experts also say that if you continue to have foul-smelling poo over a long period, you might need to see a doctor for a checkup. But if your poo smell is terrible over a brief period, it might not be an issue if normalcy in colour and odor are restored after a couple of days. The temporary foul smell could have been caused by a virus you caught or food poisoning that resolved itself after the body rid itself of the bad virus.

Medical experts also blame malabsorption (imperfect absorption of food material by the small intestine) for foul-smelling poo. They say malabsorption can be caused by a number of things like celiac disease, where the lining of the small intestine is sensitive to gluten and gets inflamed. This means that it is unable to absorb nutrients. Bowel disease like ulcerative colitis, viruses, parasites or bacteria like salmonella or e.coli, antibiotics, overdose of supplements, especially vitamins A, D, E and K can also cause foul-smelling poo.

Happily, there are non-medical remedies for normalizing the smell of poo. Experts advise that a diet high in vegetables, quality protein and healthy fats is essential for optimal gut health, which in turn translates to healthy poo that smells “normal.”  Ideally, good poo should float, not sink in water. When it sinks, it means you are not eating right, according to Dr. Martina Agberien. But people, who practice open defecation might not be able to observe if their excrement sinks or floats.

Dr. Agberien also emphasized the importance of passing stool because it is a way of getting rid of waste products of metabolism. “When one does not move the bowel regularly or one notices a change in bowel movement from the regular, it is good to seek medical attention as a lot can be detected in that simple act of change in bowel movement.” She also emphasized the need to take a good look at your stool after each bowel movement especially if it was difficult coming out.

 From my layman’s understanding, foul-smelling stool can be a sign of ill-health, but contrary to the assertion of the woman, who gave the talk, stool naturally has an unpleasant smell. One more thing, your stool can be used to determine your state of health and also detect ailments that can kill or create health problems if left untreated. That is why stool test is part of annual checkups and at other times when you fall ill.

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