Bristol stool scale explained

Bristol stool scale
Purpose:classify type of feces (diagnostic triad for irritable bowel syndrome)[1]
Synonyms:Bristol stool chart (BSC);[2] Bristol Stool Scale (BSS); Bristol Stool Form Scale (BSFS or BSF scale);[3]

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

The seven types of stool are:

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 diarrhea.[12]

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

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

Diagnosis of irritable bowel syndrome

See also: Rome process. 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.

Research conducted on irritable bowel syndrome in the 2000s,[15] [16] faecal incontinence[17] [18] [19] and the gastrointestinal complications of HIV[20] have used the Bristol scale as a diagnostic tool easy to use, even in research which lasted for 77 months.[21]

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).[22]

More recently, according to the latest revision of the Rome III Criteria, six clinical manifestations of IBS can be identified:[23] [24] [25] [26] [27]

Subtypes prevalent presentation of stool in IBS according to the Rome III Criteria[28]
1. IBS with constipation (IBS-C) – lumpy or hard stools * ≥ 25% and loose (soft) or watery stools † <25% of bowel movements. ‡
2. IBS with diarrhea (IBS-D) – loose (soft) or watery stools † ≥ 25% and lumpy or hard stools * <25% of bowel movements. ‡
3. Mixed IBS (IBS - M) – lumpy or hard stools * ≥ 25% and loose (soft) or watery stools † ≥ 25% of bowel movements. ‡
4. Untyped IBS (IBS - U) – insufficient stool abnormalities to be IBS-C, D or M ‡

Notes and References

  1. What to know about the Bristol Stool Chart or Bristol Stool Scale.. N.p.: Dr.Hakim Saboowala, 2022.
  2. Amarenco G. 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. fr. Progrès en Urologie. 24. 11. 708–13. 2014. 25214452. 10.1016/j.purol.2014.06.008.
  3. https://www.gutsense.org/constipation/normal_stools.html Gut Sense
  4. Harvey . Samuel . Matthai . Sona . King . David Anthony . How to use the Bristol Stool Chart in childhood constipation . Archives of Disease in Childhood: Education and Practice Edition . 27 September 2022 . 108 . 5 . 335–339 . 10.1136/archdischild-2022-324513. 36167665 . 252567021 .
  5. Koh. H . Lee. MJ. Kim. MJ . Shin. JI. Chung. KS. Simple diagnostic approach to childhood fecal retention using the Leech score and Bristol stool form scale in medical practice. J Gastroenterol Hepatol. 25 . 2. 334–8. February 2010 . 10.1111/j.1440-1746.2009.06015.x. 19817956. 46258249.
  6. Corsetti. M.. P.. De Nardi. S.. Di Pietro. S. . Passaretti. PA.. Testoni. C.. Staudacher. Rectal distensibility and symptoms after stapled and Milligan-Morgan operation for hemorrhoids. J Gastrointest Surg . 13. 12. 2245–51. December 2009. 10.1007/s11605-009-0983-7. 19672663 . 30157677.
  7. Wang. HJ. XM. Liang . ZL. Yu . LY. Zhou. SR. Lin. M. Geraint. A Randomised, Controlled Comparison of Low-Dose Polyethylene Glycol 3350 plus Electrolytes with Ispaghula Husk in the Treatment of Adults with Chronic Functional Constipation. Clin Drug Investig. 24. 10 . 569–76. 2004. 17523718. 10.2165/00044011-200424100-00002. 29204976.
  8. Lewis. Heaton. Stool form scale as a useful guide to intestinal transit time. Scand. J. Gastroenterol.. 1997. 32. 9. 920–924. 10.3109/00365529709011203. 9299672 . 32196954 .
  9. Book: Ackley. Betty J.. Ladwig. Gail B.. Nursing Diagnosis Handbook, An Evidence-Based Guide to Planning Care, 10: Nursing Diagnosis Handbook. 2013. Elsevier Health Sciences. 9780323085496 . 240.
  10. Bristol scale stool form. A still valid help in medical practice and clinical research G Riegler, I Esposito – Techniques in coloproctology, 2001 – Springer
  11. National Collaborating Centre for Nursing and Supportive Care . Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care . NICE Clinical Guidelines . No. 61 . February 2008. 21656972 . 17 November 2015.
  12. Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. . J Clin Med . 2017 . 6 . 11 . 99. 29072609 . 10.3390/jcm6110099 . 5704116 . Review . free .
  13. Mínguez Pérez. M.. A.. Benages Martínez. The Bristol scale - a useful system to assess stool form?. Rev Esp Enferm Dig. 101. 5. 305–11. May 2009. 19527075. 10.4321/s1130-01082009000500001. free.
  14. Lewis. SJ.. KW.. Heaton. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 32. 9. 920–4. September 1997. 10.3109/00365529709011203. 9299672. 32196954 .
  15. Yilmaz. S.. M.. Dursun. M.. Ertem. F.. Canoruc. A.. Turhanoğlu. The epidemiological aspects of irritable bowel syndrome in Southeastern Anatolia: a stratified randomised community-based study. Int J Clin Pract. 59. 3. 361–9. March 2005. 10.1111/j.1742-1241.2004.00377.x. 15857337. 25617758. free.
  16. Adibi. P.. E.. Behzad. S.. Pirzadeh. M.. Mohseni. Bowel habit reference values and abnormalities in young Iranian healthy adults. Dig Dis Sci. 52. 8. 1810–3. August 2007. 10.1007/s10620-006-9509-2. 17410463. 23444977.
  17. Macmillan. AK.. AE.. Merrie. RJ.. Marshall. BR.. Parry. Design and validation of a comprehensive fecal incontinence questionnaire. Dis Colon Rectum. 51. 10. 1502–22. October 2008. 10.1007/s10350-008-9301-9. 18626716. 24237764.
  18. Chung. JM.. SD.. Lee. DI.. Kang. DD.. Kwon. KS.. Kim. SY.. Kim. HG.. Kim. du G.. Moon. KH.. Park. YH.. Park. KS.. Pai. An epidemiologic study of voiding and bowel habits in Korean children: a nationwide multicenter study. Urology. 76. 1. 215–9. July 2010. 10.1016/j.urology.2009.12.022. 20163840.
  19. El-Gazzaz. G.. M.. Zutshi. L.. Salcedo. J.. Hammel. R.. Rackley. T.. Hull. Sacral neuromodulation for the treatment of fecal incontinence and urinary incontinence in female patients: long-term follow-up. Int J Colorectal Dis. 24. 12. 1377–81. December 2009. 10.1007/s00384-009-0745-8. 19488765. 23151233.
  20. Tinmouth. J.. G.. Tomlinson. G.. Kandel. S.. Walmsley. HA.. Steinhart. R.. Glazier. Evaluation of Stool frequency and stool form as measures of HIV-related diarrhea. HIV Clin Trials. 8. 6. 421–8. 10.1310/hct0806-421. 18042507. 2007. 7464234.
  21. Zutshi. M.. TH.. Tracey. J.. Bast. A.. Halverson. J.. Na. Ten-year outcome after anal sphincter repair for fecal incontinence. Dis Colon Rectum. 52. 6. 1089–94. June 2009. 10.1007/DCR.0b013e3181a0a79c. 19581851. 31730098.
  22. Longstreth. GF.. WG.. Thompson. WD.. Chey. LA.. Houghton. F.. Mearin. RC.. Spiller. Functional bowel disorders. Gastroenterology. 130. 5. 1480–91. April 2006. 10.1053/j.gastro.2005.11.061. 16678561.
  23. Park. JM.. MG.. Choi. YK.. Cho. IS.. Lee. JI.. Kim. SW.. Kim. IS.. Chung. Functional Gastrointestinal Disorders Diagnosed by Rome III Questionnaire in Korea. J Neurogastroenterol Motil. 17. 3. 279–86. July 2011. 10.5056/jnm.2011.17.3.279. 21860820. 3155064.
  24. Dong. YY.. XL.. Zuo. CQ.. Li. YB.. Yu. QJ.. Zhao. YQ.. Li. Prevalence of irritable bowel syndrome in Chinese college and university students assessed using Rome III criteria. World J Gastroenterol. 16. 33. 4221–6. September 2010. 20806442. 10.3748/wjg.v16.i33.4221. 2932929 . free .
  25. Sorouri. M.. MA.. Pourhoseingholi. M.. Vahedi. A.. Safaee. B.. Moghimi-Dehkordi. A.. Pourhoseingholi. M.. Habibi. MR.. Zali. Functional bowel disorders in Iranian population using Rome III criteria. Saudi J Gastroenterol. 16. 3. 154–60. 10.4103/1319-3767.65183. 20616409. 3003223. 2010 . free .
  26. Miwa. H.. Prevalence of irritable bowel syndrome in Japan: Internet survey using Rome III criteria. Patient Prefer Adherence. 2. 143–7. 2008. 19920955. 2770425.
  27. Engsbro. AL.. M.. Simren. P.. Bytzer. Short-term stability of subtypes in the irritable bowel syndrome: prospective evaluation using the Rome III classification. Aliment Pharmacol Ther. 35. 3. 350–9. February 2012. 10.1111/j.1365-2036.2011.04948.x. 22176384. 205247214. free.
  28. Ersryd . A. . Posserud . I. . Abrahamsson . H. . Simrén . M. . Subtyping the irritable bowel syndrome by predominant bowel habit: Rome II versus Rome III . Alimentary Pharmacology & Therapeutics . 26 . 6 . 2007-07-02 . 10.1111/j.1365-2036.2007.03422.x . free . 17767480 . 953–961 .

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