What are the 7 types of stool?

A person’s poop can vary depending on diet, hydration, and health status. A stool that is hard, runny, or has an unusual color may indicate a health problem that needs attention. Poop is typically medium to dark brown in color.

Sometimes, poop can vary in color, texture, amount, and odor. These differences can be concerning, but usually, these changes are not significant and will resolve in a day or two. Other times, however, changes in poop indicate a more serious condition.

Keep reading to discover more about the different types of poop, including what is and is not typical.

Bristol stool chart

Devised by doctors in the Bristol Royal Infirmary, England, and based on the bowel movements of nearly 2,000 people, the Bristol stool chart characterizes the different types of poop.

Types 1 and 2 indicate constipation, types 3 and 4 are healthy stool, while types 5–7 suggest diarrhea and urgency.

Normal poop

Poop is generally:

• Medium to dark brown: It contains a pigment called bilirubin, which forms when red blood cells break down.
• Strong-smelling: Bacteria in excrement emit gases that contain the unpleasant odor associated with poop.
• Pain-free to pass: A healthy bowel movement should be painless and require minimal strain.
• Soft to firm in texture: Doctors consider poop passed in one single piece or a few smaller pieces to signify a healthy bowel. The long, sausage-like shape of poop is due to the shape of the intestines.
• Passed once or twice daily: Most people pass stool once a day, although others may poop every other day or up to three times daily. At a minimum, a person should pass stool three times per week.
• Consistent in its characteristics: A healthy poop varies from person to person. However, people should monitor any changes in the smell, firmness, frequency, or color of poop as it can indicate an issue.

How long should a poop take?

It should take 10–15 minutes to pass the stool.

People who take longer than this may have constipation, hemorrhoids, or another condition.

A person should contact a doctor if changes to poop persist for 2 weeks or more.

People should seek immediate medical treatment if the stool is bright red, black, or a tarry substance. These symptoms suggest blood loss, which could become a medical emergency if left untreated.

How to ensure healthy bowels

To help ensure healthy bowel function and healthy poops, people can follow the tips below:

• Eat enough fiber: Aim to get the recommended minimum daily amount of fiber, which is 22–34 grams (g) for adults, depending on age and sex.
• Drink plenty of water: A reasonable amount is about 8 glasses (64 ounces) per day. It is especially important to stay hydrated when consuming more fiber.
• Take probiotics: Probiotics may help restore the natural balance of bacteria in the gut. Although some yogurts and drinks can also provide probiotics, these beneficial bacteria are in capsule form.
• Try magnesium: Magnesium hydroxide often treats constipation. It is safe for most people, although doctors do not recommend it for people with renal insufficiency.
• Lifestyle changes: This may include stopping smoking, type, and level of exercise, and anxiety management to help control a person’s bowel movements.

A well-functioning digestive system is essential for health and well-being. It also suggests that a person is eating a balanced diet.

Poop abnormalities that persist can lead to complications. For example, ongoing diarrhea can result in nutritional deficiencies or, in severe cases, malnutrition, while constipation can cause bowel obstructions.

Frequently asked questions

Below are frequently asked questions relating to the different types of poop.

What are the seven types of stool?

The seven types of stool are:

• separate hard lumps
• a lumpy, sausage-like clump
• a sausage shape with cracks
• smooth sausage-shaped
• soft blobs with clear edges
• a mushy, ragged mass
• liquid

What type of stool is concerning?

Hard or lumpy stool indicates that a person has constipation, while mushy or liquid-like stool may indicate inflammation in the bowel and diarrhea.

What is the healthiest type of stool?

Smooth, sausage-shaped stool is typically the healthiest type of stool. These usually indicate proper bowel function. However, a person should contact a doctor if they notice changes in their stool or bowel habits.

What is type 5 stool consistency?

Stool type 5 on the Bristol Stool Chart refers to stool that consists of soft blobs with clear-cut edges. This might indicate that a person is lacking fiber.

What causes type 6 poop?

Stool type 6 refers to stool that has a mushy consistency with ragged edges. This might indicate that inflammation is present.

What is an unhealthy stool color?

Stool is typically brown in color. Other colors – such as red, black, yellow, green, orange, white, or pale – can indicate an underlying condition. A person should contact a doctor if they experience changes in the color of their bowel movements.

Summary

A person’s poop tends to be brown, soft to firm in texture, and easy to pass. If someone experiences changes in poop, they should monitor them and consult a doctor if the issue does not resolve within 2 weeks.

To encourage bowel function, a person should eat a fiber-rich diet, exercise regularly, reduce stress, and drink lots of water to stay hydrated.

Read this article in Spanish.

Medical system for classifying human faeces

Bristol stool chart

The Bristol stool scale is a diagnostic medical tool designed to classify the form of human faeces into seven categories.[4] It is used in both clinical and experimental fields.[5][6][7]

It was developed at the Bristol Royal Infirmary as a clinical assessment tool in 1997,[8] and 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;[9][10] including being part of the diagnostic triad for irritable bowel syndrome.[11]

Interpretation

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The seven types of stool are:[12]

• Type 1: Separate hard lumps, like nuts (difficult 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 (average stool)
• Type 5: Soft blobs with clear cut edges
• Type 6: Fluffy pieces with ragged edges, a mushy stool (diarrhea)
• Type 7: Watery, no solid pieces, entirely liquid (diarrhea)

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, and 6 and 7 indicate diarrhoea.[13]

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.[12] The initial research did not include a pictorial chart with this being developed at a later point.[8]

The Bristol stool scale is also very sensitive to changes in intestinal transit time caused by medications, such as antidiarrhoeal loperamide, senna, or anthraquinone with laxative effect.[14]

Uses

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Diagnosis of irritable bowel syndrome

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People with irritable bowel syndrome (IBS) typically report that they suffer with abdominal cramps and constipation. In some patients, chronic constipation is interspersed with brief episodes of diarrhoea; while a minority of patients with IBS have only diarrhoea. The presentation of symptoms is usually months or years and commonly patients consult different doctors, without great success, and doing various specialized investigations. It notices a strong correlation of the reported symptoms with stress; indeed diarrhoeal discharges are associated with emotional phenomena. IBS blood is present only if the disease is associated with haemorrhoids.[15]

Research conducted on irritable bowel syndrome in the 2000s,[16][17] faecal incontinence[18][19][20][21] and the gastrointestinal complications of HIV[22] have used the Bristol scale as a diagnostic tool easy to use, even in research which lasted for 77 months.[23]

Historically, this scale of assessment of the faeces has been recommended by the consensus group of Kaiser Permanente Medical Care Program (San Diego, California, US) for the collection of data on functional bowel disease (FBD).[15]

More recently, according to the latest revision of the Rome III Criteria, six clinical manifestations of IBS can be identified:[24][25][26][27][28]

* Bristol stool scale type 1–2 (Separate hard lumps like nuts or sausage-shaped);† Bristol stool scale type 6–7 (fluffy pieces with ragged edges, soft or watery, no solid or completely liquid pieces);‡ In the absence of the use of antidiarrhoeal or laxative

These four identified subtypes correlate with the consistency of the stool, which can be determined by the Bristol stool scale.[15]

In 2007, the Mayo Clinic College of Medicine in Rochester, Minnesota, United States, reported a piece of epidemiological research conducted on a population of 4,196 people living in Olmsted County Minnesota, in which participants were asked to complete a questionnaire based on the Bristol stool scale.[30]

The research results (see table) indicate that about 1 in 5 people have a slow transit (type 1 and 2 stools), while 1 in 12 has an accelerated transit (type 5 and 6 stools). Moreover, the nature of the stool is affected by age, sex, body mass index, whether or not they had cholecystectomy and possible psychosomatic components (somatisation); there were no effects from factors such as smoking, alcohol, the level of education, a history of appendectomy or familiarity with gastrointestinal diseases, civil state, or the use of oral contraceptives.

Therapeutic evaluation

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Several investigations correlate the Bristol stool scale in response to medications or therapies, in fact, in one study was also used to titrate the dose more finely than one drug (colestyramine) in subjects with diarrhoea and faecal incontinence.[31]

In a randomised controlled study,[32] the scale is used to study the response to two laxatives: Macrogol (polyethylene glycol) and psyllium (Plantago psyllium and other species of the same genus) of 126 male and female patients for a period of 2 weeks of treatment; failing to show the most rapid response and increased efficiency of the former over the latter. In the study, they were measured as primary outcomes: the number weekly bowel movements, stool consistency according to the types of the Bristol stool scale, time to defecation, the overall effectiveness, the difficulty in defecating and stool consistency.[32]

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,[33][34] moxicombustion,[35] laxatives in the elderly,[36] preparing Ayurvedic poly-phytotherapy filed TLPL/AY,[37] psyllium,[38] mesalazine,[39] methylnaltrexone,[40] and oxycodone/naloxone,[41] or to assess the response to physical activity in athletes.[42]

History

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Developed and proposed for the first time in England by Stephen Lewis and Ken Heaton at the University Department of Medicine, Bristol Royal Infirmary, it was suggested by the authors as a clinical assessment tool in 1997 in the Scandinavian Journal of Gastroenterology[14] after a previous prospective study, conducted in 1992 on a sample of the population (838 men and 1,059 women), had shown an unexpected prevalence of defecation disorders related to the shape and type of stool.[43] The authors of the former 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 for Types 1 and 2;[44] 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.[9][10]

Versions

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The same scale has been validated in Spanish,[45][20] Brazilian Portuguese,[46] and Polish versions.[47] A version has also been designed and validated for children.[48][49] More recently, in September 2011, a modified version of the scale was validated using a criterion of self-assessment for ages six–eight years of age.[50] A modified version with extended descriptions for liquid fecal material was created for ostomates.[51]

A version of the scale was developed into a chart suitable for use on US television by Gary Kahan of NewYork–Presbyterian Hospital.[52]

References

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