Bristol stool scale

Bristol stool chart

The Bristol stool scale, Bristol stool chart (BSC),^[1] Bristol stool form scale, or BSF scale^[2] is a medical aid designed to classify the form of human feces into seven categories. Sometimes referred to in the UK as the Meyers scale,^[3] it was developed by Dr. Stephen Lewis and Dr. Ken Heaton at the University of Bristol and was first published in the Scandinavian Journal of Gastroenterology in 1997.^[4] The authors of that paper concluded that the form of the stool is a useful surrogate measure of colon transit time. That conclusion has since been challenged as having limited validity, and only in types 1 and 2 when the subject is not constipated.^[5] However, it remains in use as a research tool to evaluate the effectiveness of treatments for various diseases of the bowel, as well as a clinical communication aid.^[6][7]

The Bristol stool scale is part of the diagnostic triad for irritable bowel syndrome: pain/discomfort (quality and quantity); bowel habit (quality and quantity); and bloating (in women).^[8]

The seven types of stool are:

• Type 1: Separate hard lumps, like nuts (hard to pass)
• Type 2: Sausage-shaped, but lumpy
• Type 3: Like a sausage but with cracks on its surface
• Type 4: Like a sausage or snake, smooth and soft
• Type 5: Soft blobs with clear cut edges (passed easily)
• 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 (especially the latter), as they are easy to defecate while not containing excess liquid, and 5, 6 and 7 tending towards diarrhoea.

References

1. Amarenco G (2014). "Bristol Stool Chart : étude prospective et monocentrique de « l’introspection fécale » chez des sujets volontaires" [Bristol Stool Chart: Prospective and monocentric study of 'stools introspection' in healthy subjects]. Progrès en Urologie (in French) 24 (11): 708–13. doi:10.1016/j.purol.2014.06.008. PMID 25214452.
2. Gut Sense What Exactly Are Normal Stools?, Konstantin Monastyrsky. Accessed July 2015
3. "Meyers Scale". General Practice Notebook. Retrieved 2015-05-09.
4. Lewis SJ, Heaton KW (1997). "Stool form scale as a useful guide to intestinal transit time". Scand. J. Gastroenterol. 32 (9): 920–4. doi:10.3109/00365529709011203. PMID 9299672.
5. Rao SS, Camilleri M, Hasler WL, Maurer AH, Parkman HP, Saad R, Scott MS, Simren M, Soffer E, Szarka L. (2011). "Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies". Neurogastroenterol Motil. 23 (1): 8–23. doi:10.1111/j.1365-2982.2010.01612.x. PMID 21138500.
6. Ackley, Betty J.; Ladwig, Gail B. (2013). Nursing Diagnosis Handbook, An Evidence-Based Guide to Planning Care, 10: Nursing Diagnosis Handbook. Elsevier Health Sciences. p. 240. ISBN 9780323085496.
7. Bristol scale stool form. A still valid help in medical practice and clinical research G Riegler, I Esposito – Techniques in coloproctology, 2001 – Springer
8. National Collaborating Centre for Nursing and Supportive Care, (UK) (February 2008). "Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care, NICE Clinical Guidelines, No. 61". PMID 21656972. Retrieved 17 November 2015.