Understanding Your Stool: Using the Bristol Stool Scale for Gut Health

[노윤정 약사의 건강교실]

Bristol stool scale. As a clinical tool to evaluate the state of stool developed in 1997, the shape of stool is divided into 7 types. Stool includes undigested and absorbed food, digestive juices, epithelial cells of the gastrointestinal tract, intestinal microorganisms, and short-chain fatty acids (intestinal flora metabolites).

The shape of the stool is largely determined by the amount of water in it. Normal stools have a water content of around 70%, and if it is below 60%, the stool becomes hard and constipation occurs. If it is more than 80%, the stool becomes watery or diarrhea occurs. At this time, the key to determining the amount of water in the stool is the amount of water I drink and the composition of the stool. I cannot control the amount of water we drink, but the composition of stool is not easy. In this case, ‘the shape of the stool’ is what helps to find a way to control the composition of the stool.

A Bristol stool scale that divides the shape of the sides into 7 shapes. [사진=Wikipedia]

Healthy stools, as determined by the Bristol Stool Scale, belong to types 3 and 4. Type 3 is a sausage shape, but cracks are visible on the surface, and Type 4 is a sausage or snake shape with a smooth surface. Because the amount of food and water we eat every day is different and the gastrointestinal tract movement changes depending on the situation, we cannot see these healthy stools every day.

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However, if you have frequent mutations belonging to types 1, 2, or 5 to 7, you definitely need health care. Type 1 is also called ‘rabbit poop’. Hard stools are separated into small lumps. Type 2 is sausage-shaped, but the cracks on the lumpy surface are clearly visible. This type is associated with insufficient water intake, poor dietary fiber intake, very small food intake, or slowed gastrointestinal motility. Metabolites of the intestinal flora affect the speed of gastrointestinal motility, so probiotics intake is sometimes used to improve constipation.

In types 5-7, stools are not compacted and the shape is not clear. Like type 7, watery diarrhea is related to an emergency such as an infectious disease, so treatment is given priority, but if it is a loose stool like type 5 or 6, lifestyle management is helpful. The situation in which this type of stool is most often considered is when managing ‘irritable bowel syndrome’.

Depending on the shape of the stool, the direction of irritable bowel syndrome management also changes


Irritable bowel syndrome is a functional disorder of the colon, characterized by repeated bowel movements or severe changes in bowel habits along with abdominal pain. It leads to systemic symptoms such as shoulder stiffness and fatigue, which drastically deteriorates the quality of life.

Irritable bowel syndrome is divided into constipation, diarrhea, mixed (diarrhea and constipation), and non-specific changes in bowel habits according to changes in bowel habits. In the case of constipation, more than 75% of types 1 and 2 on the Bristol Stool Scale, more than 75% of types 5-6 in diarrheal type, more than 25% of types 1 and 2, and more than 25% of types 5-6 in mixed type. Instead of 75%, it is sometimes expressed as more than 3 times a week for easy understanding.

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If you are constipated, you will need medications or supplements that facilitate bowel movements along with identifying factors that inhibit gastrointestinal motility, and in the case of diarrheal or mixed irritable bowel syndrome, identify foods that aggravate symptoms by increasing intestinal gas production and reduce intake. It is necessary to control or stop eating.

In the case of diarrhea or mixed type, there are many cases where the intake of some probiotics such as butyric acid bacteria helps rather than the constipation type. As such, the direction of management of irritable bowel syndrome varies depending on the shape of the stool, and the Bristol stool scale can be usefully used as a tool to facilitate communication between experts and patients (customers) in health counseling.

Irritable bowel syndrome with these symptoms requires professional treatment

Irritable bowel syndrome appeals to various symptoms besides digestive symptoms. It is known that more than 30% complain of gastroesophageal reflux symptoms, which occurs when stomach acid flows back into the esophagus, causing heartburn or acid reflux. When severe changes in bowel habits affect work or social life, people may experience depression due to a decrease in quality of life. If you have irritable bowel syndrome accompanied by these symptoms, you need professional treatment.

Irritable bowel syndrome patients often take probiotics to relieve symptoms, but severe symptoms are difficult to manage with simple probiotic intake. In addition to diet management, if necessary, medications such as gastrointestinal motility regulators, antispasmodics and tranquilizers that lower the sensitivity of the intestine may be used. In particular, it is important to accurately identify the anxiety factors that aggravate symptoms by checking your overall life. An expert is a person who helps patients solve problems based on many examples along with knowledge. If you are experiencing difficulties in your social life due to irritable bowel syndrome, you need expert counseling rather than searching for better probiotics.

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2023-06-03 06:00:44

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