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Bowel movement that results in something that looks like little balls of feces on a string is a common symptom of constipation and/or irritable bowel syndrome (IBS). It's a symptom that has been recognized for thousands of years. The ancient Chinese physicians wrote entire books on "string of pearls" diseases. It's a problem that occur whenever someone is:

  • Constipated,
  • Colicky (there are muscle spasms or straining and bowel movement is difficult), and
  • Eating the right foods to treat those problems but usually not getting enough water.

What you need when you are constipated is water and fiber, in that order. Just eating more fiber won't relax your bowels. In fact, insoluble fiber like the fiber in wheat products can make constipation (and acid reflux) worse. 

Fiber works by absorbing water and making feces lighter and easier to expel. If you get the fiber without the water, you can wind up with little balls of fiber that your bowel has to work hard to expel. Their ends may have trailing fiber that leads to the next plug of stool that you strain to eliminate.

People who have this symptom often have a condition called irritable bowel syndrome (IBS), with or without diarrhea. Of course, when someone who has IBS has diarrhea, they won't have stringy poop. In IBS, the gut presses so hard that even "tough" stool gets eliminated, usually with considerable pain. However, when bowel movement is mild enough that it doesn't hurt, this oddity can occur.

How can you tell whether stringy poop is just an odd phenomenon or a symptom of IBS? If you have irritable bowel syndrome, you will also:

  • Tend to have belly bloat, especially after you eat.
  • Tend to get constipation that doesn't respond to laxatives.
  • Get mild to severe abdominal pain after meals, especially after meals followed by exercise. This pain is usually "all over" the abdomen, not just on one side. It doesn't usually spread outside the abdomen, unless you have gas. Then it can be perceived as chest pain. If you have severe gas, then you may have worse pain on the left side of your abdomen.
  • Defecation can be accompanied by profuse sweating and feeling faint.

In North America, these symptoms are more common among women. In Asia, they are more likely to occur in men. They often start in childhood and stay with a person throughout life, but they don't get treated for decades because people just don't want to talk with their doctors about this sort of thing.

If you have the "string of pearls poop" and any of these symptoms, your best bet is to let your doctor diagnose and treat you. If that's not possible, then it also usually helps to:

  • Avoid laxatives that contain psyllium husks, like Metamucil. Polycarbophil laxatives such as Citrucel and Fibercon cause less gas and less stringy poop.
  • Drink at least 2 liters (8 cups) of water every day. You don't need to slosh when you walk, but you have to avoid dehydration.
  • Dietary changes may or may not help. Some people benefit from probiotics, but others don't. Some people benefit from avoiding wheat products, but others don't. Some people actually need less fiber, but others need more. You may need to experiment with diet to discover what works. It nearly always helps to eat smaller meals, and, if you have a lot of belly fat, to lose weight to take pressure off your bowel.

Another remedy that sometimes works wonders is peppermint. Peppermint tea, peppermint candies (such as Altoids), and peppermint remedies such as IBGard can relieve symptoms, including the stringy poop problem. Just don't neglect fiber and fluid.

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