"Everybody looks at their poop."
If Oprah said it, it must be true. Inspired by a visit from Dr. Oz on an old episode of her phenomenally popular show, Oprah told us what we all already know but were perhaps too dainty or proper to admit: everybody examines their poop from time to time. It’s normal and appropriate to peer down into the porcelain throne and take a look at what just came out of our body.
While it can be a topic too taboo for some, the fact remains that the look of our feces can tell us important information about our digestive health. But without a guide to show us the way, we might be tempted to jump to all sorts of conclusions—some of which may even leave us overly concerned or afraid. Fortunately, medical science has come to the rescue in recent decades, and now we have a useful and comprehensive tool for checking our stool.
What is the Bristol Stool Scale?
In 1997, Ken Heaton and Stephen Lewis, doctors from the Bristol Royal Infirmary in Bristol, UK, developed a classification chart that would serve as a diagnostic and communication tool for patients with gastrointestinal maladies. The chart, now known as “the Bristol Stool Scale” (also sometimes referred to as the “Bristol Stool Form Scale” or the “Bristol Stool Chart”) and published in the Scandinavian Journal of Gastroenterology, was the result of robust research into the dietary habits of a sample group of volunteers.
The original proposal from Heaton and Lewis was that the form of the stool should reliably demonstrate the transit time it takes the stool to pass through the colon. While more recent research has questioned the usefulness of some parts of the chart, it is still widely used and respected by medical practitioners all over the world.
The scale is particularly helpful at giving concerned patients a great overview of what ideal stools should look like. It does this by dividing the potential stool forms into seven types along a continuum of consistency and shape:
- Type 1: Separate hard lumps that are difficult to pass
- Type 2: Shaped like a sausage with smooth, irregular bumps
- Type 3: Shaped like a sausage with a smooth but cracked surface
- Type 4: Shaped like a smooth and soft sausage with no cracks
- Type 5: Soft blobs with clear cut edges that are easy to pass
- Type 6: Mushy stool—fluffy pieces with ragged edges
- Type 7: Primarily liquid with no consistent solid pieces
What is Normal Poop?
The Bristol Stool Scale considers Types 3 and 4 to be “normal” or generally healthy poop. All things being equal, your poop should ideally be shaped like a sausage or log with a smooth surface and be relatively easy to pass. While the chart doesn’t speak specifically to frequency, doctors commonly indicate that a healthy pattern of bowel movements should be anywhere from one to three times per day to three times per week.
By contrast, Types 1-2 on the scale typically indicate constipation, the inability to have a bowel movement. There are a variety of reasons why you could be constipated—most of which are temporary and non-serious. Types 5, 6, and 7 on the scale are the opposite situation and typically indicate some gradation of diarrhea; this, too, can be caused by a variety of factors.
One of the greatest benefits of the chart is the ability to have a common language to use when speaking with your doctor. If you have been experiencing one of the non-normal poops on the list, you can use the chart to help you explain to the doctor what you see when you look in the toilet, and that will better assist your doctor in making a diagnosis.
What Does a Person’s Poop Color Mean?
Beyond the shape and form, many people ask about the color of their poop. What should it look like? What is normal? The Bristol Stool Scale doesn’t comment on color, but other research has shown that the color can be an indicator of a number of conditions:
Brown: As you probably expected, brown is good. You might see various shades of brown, but really anything in the brown realm is a good indicator of bowel health.
Green: While some slight green tinge can be normal and even expected, poop that is vividly green can be either a sign that you’ve been eating a lot of green foods (like spinach) or that your poop is passing through your digestive system too quickly.
Black: This can be a sign of a variety of situations, from intaking too much iron or bismuth to bleeding in your digestive tract. It can even be as simple as eating too much black licorice.
White: Anything close to pale or white, including a color akin to clay, can indicate excessive bile in your poop; extra bile can show up if the duct from your gallbladder is blocked for some reason.
Yellow: Yellow poop sometimes goes along with it being greasy and with an especially pungent odor; this usually means there is an excessive amount of fat in the stool. It can also be a sign of celiac disease, a condition involving the malabsorption of nutrients from your diet.
Red: Apart from some intensely red-colored foods (like tomato juice, beets, or berries), the most likely explanation for red poop is blood. Bleeding in your gastrointestinal tract can be caused by a variety of conditions, so it is wise to see a doctor if you see red poop and can rule out red foods.
What Are the Signs of a Healthy Bowel?
An informed and inquisitive observation of one’s poop can provide plenty of information for an informal check of your bowel health. When you look down after your next bowel movement, you ideally want to see a smooth, brown, sausage-shaped log a few inches in length. Moreover, if that’s happening frequently throughout the week, then you can rest assured that your bowel health is in tip-top shape.
If you see a few irregularities, that doesn’t necessarily mean that you have a big problem, however. Look at the Bristol scale and evaluate what it might indicate about your diet and bowel habits. Maybe you need less fat in your diet. Or more fiber. Or you might need to be drinking more water.
Healthy Poop, Healthy Life
As Oprah says, we all look at our poop in the toilet bowl and wonder what it’s telling us. If you pay attention and heed the wisdom of the Bristol Stool Scale, you’ll be well on your way to noticing when something isn’t right. Your bowel health is important to your overall health, and it is directly related to a variety of other conditions you might be susceptible to in your life.
As with any potential health condition, though, the important thing is not to panic if something seems out of the ordinary. This is also why it’s important to make regular visits to your doctor; the more you’re aware of how your body is functioning—and when it seems to be “malfunctioning”—the better you’ll be able to determine when you need to bring a concern to the doctor’s attention.
If you are seeing a stool status that doesn’t seem right, like a change in diameter—especially if it has been going on for more than a week or two—make an appointment to see a specialist. The professional doctors and staff at Carolina Digestive Health Associates are experts in bowel health and can help you figure out what your poop is trying to tell you.