Bristol Stool Scale

Human feces

The Bristol stool scale is a diagnostic medical tool designed to classify the form of human feces into seven categories. It is used in both clinical and experimental fields. It was developed at the Bristol Royal Infirmary as a clinical assessment tool in 1997.

It is widely used as a research tool to evaluate the effectiveness of treatments for various diseases of the bowel, as well as a clinical communication aid; including being part of the diagnostic triad for irritable bowel syndrome.

The seven types of stool are:

Type 1: Separate hard lumps, like nuts (difficult to pass and can be black)
Type 2: Sausage-shaped, but lumpy
Type 3: Like a sausage but with cracks on its surface (can be black)
Type 4: Like a sausage or snake, smooth and soft (average stool)
Type 5: Soft blobs with clear cut edges
Type 6: Fluffy pieces with ragged edges, a mushy stool
Type 7: Watery, no solid pieces, entirely liquid

Types 1 and 2 indicate constipation, with 3 and 4 being the ideal stools as they are easy to defecate while not containing excess liquid, 5 indicating lack of dietary fiber, and 6 and 7 indicate diarrhea.

In the initial study, in the population examined in this scale, the type 1 and 2 stools were more prevalent in females, while the type 5 and 6 stools were more prevalent in males; furthermore, 80% of subjects who reported rectal tenesmus (sensation of incomplete defecation) had type 7. These and other data have allowed the scale to be validated. The Bristol stool scale is also very sensitive to changes in intestinal transit time caused by medications, such as antidiarrheal loperamide, senna, or anthraquinone with laxative effect.

From 2010, several studies have used the scale as a diagnostic tool validated for recognition and evaluation of response to various treatments, such as probiotics, moxicombustion, laxatives in the elderly, preparing Ayurvedic poly-phytotherapy filed TLPL/AY,[34] psyllium, mesalazine, methylnaltrexone, and oxycodone/naloxone, or to assess the response to physical activity in athletes.

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