If you’ve ever looked down into the toilet after pooping to examine what came out, you’re not alone. Pooping is a natural bodily function, and it’s equally natural to want to evaluate what you see. While it can be a weird or taboo topic, the appearance of feces can tell us important information about our digestive health. But it can also be difficult to interpret what we see without some kind of guide. Fortunately, the Bristol Stool Chart was developed to be just such a guide.

What is the Bristol Stool Chart?

The Bristol Stool Chart (also known as the Bristol Stool Scale) was developed by British doctors Ken Heaton and Stephen Lewis in 1997 to serve as a clinical assessment tool for patients with gastrointestinal conditions. The chart was originally published in the Scandinavian Journal of Gastroenterology and was based on a 1992 study that showed a strong correlation between defecation disorders and the shape and type of stool. In the years since then, the chart has been validated numerous times by other researchers in other countries around the world.

In essence, the Bristol Stool Chart is a classification system for human feces that can be used in both clinical and experimental fields. The seven categories on the chart are arranged in a continuum from hard and dry to liquid with the points along this continuum corresponding to how much time the stool spends in the colon. The chart is helpful in determining whether a person's stool is normal or not, and it can provide clues to the underlying cause of any digestive issues. The seven categories 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

Rather than a set of hardline rules, the Bristol Stool Chart is a series of guidelines that can help in the diagnosis of a condition. It also provides a way for patients to communicate with their doctor about their experience. Instead of awkwardly trying to characterize the consistency of their poop, patients can use the chart to explain what they’ve observed.

What Counts as “Normal” Poop?

According to the Bristol Stool Scale, types 3 and 4 are considered a “normal” or healthy consistency for poop. It would ideally be sausage-shaped with a smooth surface and relatively easy to pass. Though the chart doesn’t take frequency into account, this consistency also tends to match up with the principles in gastroenterology of a healthy pattern of bowel movements. This can be different for different people, but the range can be anything from three times a day to three times a week.

At the other ends of the spectrum are less ideal consistencies that suggest the possibility of a disease, disorder, or unbalanced diet. Types 1 and 2 on the scale are drier and harder to pass, and they may indicate a problem with constipation. This means that the stool has been in the colon too long and therefore too much water has been absorbed. Types 5, 6, and 7 are looser or more liquid and are associated with diarrhea. Looser stools mean that the stool has spent too little time in the colon and too little water has been absorbed.

What Does Poop Color Indicate?

One aspect of poop that the Bristol Stool Chart doesn’t fully explore is the color. The color may not even be related to consistency or bowel motility at all, but it can still tell us something about our digestive health and whether or not there is a problem that needs to be addressed. Below are different stool colors that can be encountered and what they may indicate:

  • Brown: As with types 3 and 4 above, brown is generally considered a normal and healthy color for poop. The brown color comes from a combination of the pigments in bile and bilirubin, a compound that breaks down dead red blood cells.
  • Black: Black poop can be a sign of too much or iron or bismuth in the body as well as bleeding in the upper gastrointestinal tract. Black stool may also be a result of eating certain foods like black licorice.
  • Green: Because bile has a yellow-green color, some greenish tint may be normal from time to time. Green poop can also be a sign of infection or large amounts of unprocessed bile. Poop can also be very green after eating a lot of green food like kale or spinach.
  • White: White or very pale poop usually means an insufficient amount of bile in the digestive tract; one of the most common reasons for this is the duct from the gallbladder being blocked by a gallstone.
  • Yellow: There are numerous reasons poop can be yellow, but it is usually also greasy and foul-smelling. This typically means there is a high amount of fat or gluten in the stool, either from dietary sources or because of a condition like celiac disease. It may also mean that food has passed through the digestive tract too quickly.
  • Red: For most people, red poop is probably related to a food that was consumed that has a red color like tomato juice or beets. However, red poop can also indicate bleeding in the lower gastrointestinal tract, and there can be many different causes for this.

    Striving for Healthy Poop

    The consistency and color of your poop can provide useful information about the state of your digestive health. And although the Bristol Stool Chart is a good tool for anyone to look at, it’s best to interpret what you see with your doctor’s help. In general, one or two instances of abnormal poop shouldn’t be a concern, but if you are experiencing a pattern that lasts for weeks, it may be time to consult a gastroenterologist. In the meantime, here are some tips for how to improve your digestive system and the consistency of your poop:

    • Fiber: Many people simply don’t get enough dietary fiber each day. Men should be aiming for around 38g per day and women should aim for 25g a day.
    • Water: Sufficient hydration is one of the most important things you can do to help with bowel regularity. It helps the contents move smoothly through the intestines and makes constipation less likely.
    • Exercise: Exercise is beneficial for bowel motility in addition to being good for your overall health. The CDC recommends everyone get at least 150 minutes of moderate-intensity exercise each week.

    Contact Cary Gastro

    Poo might be a little awkward to talk about, but it represents a key aspect of our health and wellbeing: digestive health. At Cary Gastro, we know how important good digestive health is for everyday quality of life. If you have been experiencing a pattern of abnormal poop—or if your bowel habits have changed significantly recently—please contact us to request an appointment. Our compassionate and understanding staff is eager to talk with you and help you get healthy as soon as possible.