Apply market research to generate audience insights. Measure content performance. Develop and improve products. List of Partners vendors. There are times when you might look into the toilet after a bowel movement and see a pill or tablet only partially digested. People who see this might wonder if something is wrong with their digestion or if a medication is working like it's supposed to. However, seeing undigested drugs in your stool doesn't necessarily mean that there is anything wrong with your digestive tract.
Learn why this may occur and when to discuss it with your healthcare provider. Drug companies make many different types of coatings to ensure that a drug dissolves when it is supposed to and at the correct rate for the drug to work. These include tablets marked "extended-release" or "sustained-release" as well as capsules that contain the active drug in a powdered or pellet form.
In most cases, the body's digestive acids will break down the outer shell, but not always. This is especially true with certain capsules. In some cases, the shell will remain intact and be expelled from the body largely intact. But, while you may think the medication has not been absorbed, it actually has. It is similar to the digestion of corn kernels, where the inner grain is absorbed but the tough fibrous husk passes through into stool.
The best way to tell if a drug has been absorbed is to poke around in your stool and check if the shell contains any traces of medication. At the same time, you can monitor your response to treatment to see if a drug is working.
For instance, if you are taking medications for diabetes and your blood sugar remains normal , there is a good chance the medications are getting absorbed properly. When in doubt, talk to your healthcare provider.
They can tell you if this is a common situation and prescribe an alternate drug if needed. Extended-release capsules have a special outer coating designed to be absorbed slowly. Although the active drug may be released, the shell can sometimes pass through only partially digested. In rare cases, there may be gastrointestinal motility problems that prevent a drug from being properly absorbed. Motility refers to the muscle contractions that move food and other substances through the intestines.
If the contractions are too fast, referred to as rapid dysmotility , a tablet or capsule may pass through the intestines undigested.
Diarrhea is a common example of this. Causes may include:. Some of these conditions, like celiac disease, also cause malabsorption in which the intestines are less able to absorb nutrients and medications. If you are not absorbing your medications properly, then there is a good chance you are also not getting nutrients from your food either.
Medications may come out of the body undigested if the intestines contract faster than normal. Upon presentation, the patient reported that for the last two months he started to notice pearly oval structures in his stool accompanying his chronic abdominal pain. This had coincided with initiation of his nifedipine pills for his hypertension. He reported seeing these undigested pills daily in his stool.
The undigested pills may pose a cause of concern for both patients and physicians alike, as demonstrated in this case report, because they can mimic a parasitic infection. This can result in unnecessary extensive work-up. It is important to review the medication list for extended release formulations and note that the outer shell can be excreted whole in the stool.
Orally ingested medications have undergone a transformation over the years. In order to improve compliance by decreasing frequency, the pharmaceutical industry developed controlled release formulations. Immediate release medications usually need to be dosed frequently to maintain blood levels or usually can cause gastrointestinal irritation.
As controlled release pill formulations are released slowly, the outer capsule shell may be seen undigested in the stool. This may be a source of considerable anxiety for both the physician and the patient. This caused a lot of alarm for the patient which resulted in him receiving unnecessary investigations.
The patient reported no history of recent travel inside or outside the country, no well water ingestion, or any camping trips. He denied smoking, alcohol, or substance abuse. He reported no family history of inflammatory bowel disease or colon cancer. He denied that he had ingested any foreign body. His laboratory work-up including a complete blood count, complete metabolic panel, and a computed tomography scan was unrevealing for pathology.
Our differential included ingestion and passage of foreign body, parasitic infection, or undigested pills. Stool studies were conducted on three separate visits looking for ova and parasites but were negative. The medication history was revisited, but this time it was done in liaison with a pharmacist.
With the advent of extended release formulations, there have been times where these extended release capsules are excreted in stool.
It just sits around the tablet, forming a kind of barrier that prevents more water getting in and dissolving the rest. Eventually, the water becomes saturated; it hits a point where any more of the stuff can't dissolve. When that happens, saturated water within that network of spongy holes migrates to the edge of the pill, ensuring that the same amount of the drug is released throughout the day.
Of course, the reality in your body is far more complicated. Stomachs are dynamic and filled with hydrochloric acid, pills have a huge range of methods to prolong their release, and this is a very simple picture of dissolution.
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