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Breaking Down the Bristol Stool Chart

Everybody poops. It may be uncomfortable to discuss, but this statement is true.

What’s more, your poop (or stool) provides you with a lot of valuable information about what's going on in your body, especially when something is going wrong.

I wanted to author this blog as a complete "guide" (if you will) to how the size, shape, color and consistency of your stool can help you determine the state of your gastrointestinal health.

Basically, it’s a chart that uses the shape and consistency of your stool to determine motility and transit time. The scale was created in 1997 by a team of doctors at the British Royal Infirmary in Bristol, England. It has since become a useful diagnostic tool for coaches, doctors and clinicians who work with individuals who have gastrointestinal disorders like IBS, or who are experiencing changes in their bowel habits.

In addition to stool shape and consistency however, it’s also important to take into account other stool characteristics such as volume or size, smell, frequency of deification, color, whether or not it is easily removed from the toilet bowl when you flush, if it sinks or floats, passes easily or not, and if theres mucus or blood present.

There are seven categories of stool on the Bristol Stool chart:

  • Type 1: Separate hard lumps (hard to pass)

  • Type 2: Lumpy, sausage-shaped

  • Type 3: Sausage-shaped with cracks on the surface

  • Type 4: Sausage-shaped or snake-like; smooth and soft

  • Type 5: Soft blobs with clear-cut edges (easy to pass)

  • Type 6: Fluffy pieces with ragged edges; mushy

  • Type 7: Entirely liquid, watery, no solid pieces

Technically Type 4 is what’s labeled as “ideal” but I always encourage my clients to remember that what is considered a "normal" bowel movement varies from one person to another and there are many factors that influence bowel habits.

A few common reasons you may experience a change in bowel habits can include:

  • Diet

  • Stress

  • Travel

  • Dehydration

  • Medications

  • Age-related changes

  • Activity levels and exercise or lack of

  • Illness (such as gastroenteritis or "food poisoning")

  • Hormone-related changes such as during menstruation or pregnancy

  • More serious conditions such as inflammatory bowel disease or colon cancer

In general bowel habits are considered to be regular if you have a bowel movement anywhere from one to three times a day.

Contrary to what many in the medical community would have you believe I do not subscribe to the school of thought that it’s “normal” or “okay” to go a few days without a bowel movement. A healthy bowel should produce a daily movement.

Whats not normal to me, is having too many loose stools (diarrhea) or too many hard stools (constipation). Striking a balance in the middle is the goal, with a stool that is easily passed without any pain or discomfort.

Before I break down each type of stool, it’s important to understand what comprises stool to begin with.

What Is Stool?

Your stool is actually comprised of 75% water which is why dehydration is such a contributing factor to constipation. The remaining solid matter is 25-50% microbes (bacteria), fiber, mucus, and exfoliated gut lining.

Digestion begins in the mouth, with chewing. After food is swallowed, it travels down through the esophagus and into the stomach where it mixes with digestive juices.

After the stomach breaks down the food, it moves into the small intestine where more digestive enzymes are added and nutrients are absorbed by small fingerlike hairs called villi.

It then continues along the digestive tract and into the large intestine. In the large intestine, water is absorbed. At the end of its trip through the large intestine and the digestive tract, stool passes into the rectum and then out of the anus as stool.

The Seven Stool Types

Type 1: Separate hard lumps (hard to pass). This type indicates constipation or a very slow transit time. It’s also typical for acute dysbacteriosis. These stools lack a normal poop consistency because bacteria are missing and there is nothing to retain water. Due to the slow transit time the colon also soaks up a lot of the water which hardens the stool. This type of stool is common following a treatment of antibiotics or with people attempting a fiber-free (low-carb) diet. Flatulence isn‘t likely, because fermentation of fiber isn‘t taking place

Type 2: Sausage shaped lumpy stool. This type represents a combination of Type 1 stools impacted into a single mass and lumped together by fiber components and some bacteria. Typical for organic constipation and indicates a slow transit time. Minor flatulence is probable. These stools are often painful to pass and may require straining which increases the likelihood of hemorrhoids or diverticulosis.

Type 3: Sausage like with cracks on the surface. This form has all of the characteristics of Type 2 stools, but the transit time is faster, indicative of latent constipation. It’s considered normal, because there’s enough water for it to form and pass but the cracks still indicate it’s more dry then the ideal. Flatulence is likely minor, because of dysbacteriosis. Typically some straining is still required which can rapidly deteriorate into hemorrhoidal disease.

Type 4: Sausage-shaped or snake-like; smooth and soft. This is considered the ideal stool. It’s easy to pass. It indicates regular or daily elimination, healthy transit time, and ample water and bacteria. The larger the movement the more fiber in the diet.

Type 5: Soft blobs with clear-cut edges (easy to pass). I consider this normal, even ideal. It’s common for someone with a slightly faster transit time, or a fast digester, or someone who has stools 2-3 times per day. If you are going more then once sometimes the compaction that creates one long movement doesn’t have time to occur. It can also indicate a lack of fiber as fiber creates bulk.

Type 6: Fluffy pieces with ragged edges; mushy. This stool is considered a mild type of diarrhea. It has a sense of urgency and may be difficult to control. Otherwise, I consider it borderline normal. This kind of stool may suggest a slightly hyperactive colon (fast motility), excess dietary potassium, or sudden dehydration or spike in blood pressure related to stress (both cause the rapid release of water and potassium from blood plasma into the intestinal cavity). It can also indicate a gastrointestinal response to stress, too many spices, drinking water with a high mineral content, or the use of osmotic laxatives.

Type 7: Diarrhea . This type of stool is liquid with no solid pieces and very dangerous if it’s ongoing. Under acute and appropriate circumstances this is the body’s intelligent way of protecting itself by quickly eliminating toxins or pathogens (infection or parasites). It also can be a form of “paradoxical diarrhea” typical for people affected by fecal impaction—a condition that follows or accompanies type 1 stools. During paradoxical diarrhea the liquid contents of the small intestine have no place to go but down, because the large intestine is stuffed with impacted stools (constipation). Some water gets absorbed, the rest accumulates in the rectum. The reason this type of diarrhea is called “paradoxical” is because being severely constipated and experiencing diarrhea all at once, is, indeed, a paradoxical situation. Unfortunately, it‘s common to have alternating bouts of type 1 stools and then type 7.

What About Unusual Colors?

Stool can come in a variety of colors and still be considered "normal" but if a change goes on for more than 3 days or can't be traced back to a food or a supplement, it’s best to speak to a doctor.

Healthy bowel movements tend to be varying shades of brown, due to bile from your gall bladder being metabolized by the bacteria in your intestines.  This results in a byproduct called stercobilin, which, in turn, makes poop look brown-ish.

Some of the common reasons for differently colored stool (stool that isn’t brown) are:

  • Red: Red food coloring and ted foods such as beets can give a reddish hue to the stool. However it can also mean blood in the stool which is never normal, and should always be checked out by a doctor. It could mean bleeding from hemorrhoids, intestinal infection, IBD, Diverticular bleeding, Arteriovenous malformations (abnormal communications between arteries and veins in the wall of the intestine that rupture), or bleeding from the an ulcer in the esophagus, stomach, or duodenum.

  • Black: If stools are black, tarry, and foul-smelling, this could also be from blood and should be discussed with a doctor right away. It often means bleeding in the GI system, most often from the upper GI tract including the esophagus, stomach, and duodenum. Red blood cells are broken down by digestive enzymes in the intestine and that turns the stool black.

  • Green: Poop can turn green for a number of reasons, like eating a lot of high-chlorophyll plants such as spinach or kale, taking a course of antibiotics, or a bacterial infection. But it can also mean there is bile pigment in the stool. If food moves too quickly through the intestine, bile pigment can’t break down sufficiently.

  • Orange: Red or orange foods and some medications can cause this color. Fir example if you consume excess beta-carotene from foods like carrots, sweet potato, squash, some leafy greens, and some herbs.

  • Pale or Grey. Sometimes pale stool indicates a blocked bile duct. It can also mean Giardiasis, an infection of the intestinal tract by a microscopic parasite called giardia. It could also be an indicator of a pancreatic disorder, liver disorder or gallbladder disorder.

  • Yellow, greasy, foul smelling stool. This is often due to the intestine's inability to digest and absorb fat. This inability to properly digest fat could be due to a disease of the intestinal lining (for example celiac disease and cystic fibrosis) or because the pancreas is unable to manufacture adequate digestive enzymes (chronic pancreatitis or pancreatic cancer that blocks the pancreatic duct) , or there may not be enough bile being delivered to the intestine (such as in cancer of the liver or bile ducts that are blocked). Often people with IBS/IBD struggle with fat malabsorption as well. The yellowness, greasiness, and foul smell is due to the undigested fat.

It's also worth addressing stool that floats. Most of the time, a floating stool is the result of something you ate. If you eat something that causes gas, the gas mixes in with stool in the intestines. The extra air makes poop less dense, causing it to float when it hits the toilet bowl. Foods that contain large amounts of sugar, lactose, starch, or fiber, such as beans, milk, cabbage, apples, soft drinks, and sugar-free candies can cause poop to float. Floating poop can also result from the use of certain medications or conditions known to disrupt the absorptive lining of the intestines like Crohns, Graves, celiac, bacterial overgrowth, short bowel syndrome, etc.

IN SUMMARY: The Bristol Stool Chart can help give you a visual guide to evaluating GI health based upon the shape and consistency of your stool. However keep in mind that other stool characteristics can and should be taken into consideration. Also remember that normal stools for one person may be abnormal for another. The degree of normality is based upon a variety of factors.

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