What Your Poop Reveals About Your Health
Normally, you do your business in the bathroom and get out. Who wants to linger? But here’s the thing: Paying attention to your poop is an important way to monitor your health, helping you know when to go to your doctor for new, persistent, changes. And look, we know poop is not the easiest thing to talk about, even to your doctor, who can talk about anything … But there is a tool—dare we say, a “stool tool”—that can assist.
Why Poop Matters
Getting a better sense of what your poop looks like can help you understand your body and track any changes, says Pradeep Kumar, M.D., a gastroenterologist, partner at Austin Gastroenterology, and clinical professor at the Dell Medical School at The University of Texas at Austin. The Bristol Stool Chart provides a common “poo language” for patients and doctors by illustrating and describing stool types, says David M. Poppers, M.D., Ph.D., a gastroenterologist at NYU Langone Health in New York City. You can use it to explain what you see in the toilet, daily. Here’s how.
What Our Poop Can Tell Us
Our stool is like a window into our bodily functions, Dr. Kumar says. It can show whether you’re getting enough fiber, for example, or if we’ve had enough aerobic exercise to stimulate “intestinal tract motility” (a fancy way of saying, getting the poo moving out of your body). Consistent, progressive changes can also potentially (emphasis on potentially) be caused by colon-related conditions, like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), Celiac disease, or even colorectal cancer. So taking a look before you flush, and tracking consistent changes, can be one small piece of your overall health puzzle.
What the Bristol Stool Chart Isn’t
The Bristol Stool Chart isn’t a main diagnostic tool for any poo-related condition—it’s part of larger clinical assessments to determine if chronic changes in your stool’s consistency, size, and habits are concerning. “What’s more important to me is not the type 1 versus type 7, but if there’s a change,” Dr. Kumar explains. “We don’t use the Bristol Stool Chart in a vacuum. We use it in context, with a host of all the other symptoms. The score from 1 to 7 isn’t a grade of improvement or deterioration, it isn’t a spectrum from good to bad. It’s a descriptor that’s completely neutral.”
What the Bristol Stool Chart Is
This guide shows a range of normal poop to help you realize you’re not likely unhealthy just because your poop looks “off” on any given day. “You look at the chart and you find something that matches with the caliber of your stool, and you’re like, OK, there’s other people like me, I’m not unique. There’s not something ‘wrong with me’ because my stool looks this way,” Dr. Kumar says. “It’s a relief.” Changes of note are those that start, stay the same, and don’t stop on opposite ends of the type spectrum. Now let’s get to the types.
Type 1: Hard Lumps
On the Bristol Stool Chart, Type 1 is defined as stool that is separate hard lumps, resembling pellets. They can be hard to pass. This type could indicate constipation, Dr. Poppers says. Many factors, all normal, can cause this type, from medicine to travel to not drinking enough liquid or consuming enough fiber. If you’ve had this type of poop forever, it could be your body’s typical bowel movement—but if it makes you uncomfortable, causes problems like hemorrhoids (see your doctor if you have persistent blood with stool), or is a new consistent change, see your healthcare professional.
Type 2: Sausage-shaped But Lumpy
Type 2 is bumpy, lumpy, and shaped like a sausage. This one could be constipation too, Dr. Poppers explains. If you’ve been doing all the right things—adequate water intake (about 15.5 cups a day for men and about 11.5 cups of fluids a day for women), fiber (25 to 30 grams a day from food), and exercise (weekly for 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity)—but had types 1 or 2 for months (or even years), this might be an IBS/functional bowel disorder. Check in with your doctor.
Type 3: Sausage-shaped With Cracks
This type of poop is sausage-like but with cracks (and no lumps). It’s considered typical poo and a sign that all systems are literally a go. It doesn’t necessary mean you are healthy or unhealthy—you could very well have other issues going on that don’t impact your poo that day, says Dr. Kumar, but it does give you a baseline on how your digestive system is working: Your fiber, water, and exercise are likely all good. “Type 3 is one step closer to the firmer consistency of [type 4],” Dr. Poppers says.
Type 4: Sausage-shaped and Smooth
For this type, your poop resembles a sausage or snake, and is smooth or soft. This type is also considered typical. It’s easy to pass. You might have this type, and that’s great. Or you might not, and that’s OK too. “While we would ideally target a Bristol 4 for all patients, it’s not achievable in all patients,” Dr. Poppers says. Maybe some days you forget to drink enough water. Even COVID-19 has a high level of GI symptoms, like diarrhea, nausea, and vomiting, happening in 30%-50% cases.
Type 5: Soft Blobs Passed Easily
Type 5 on the Bristol Stool Chart is soft blobs with clear edges that are passed easily. This type—along with types 6 and 7—might be diarrhea with an urgency to go. And here’s something that might come as a surprise: This type (and types 6 and 7) could potentially mean you don’t have enough fiber in your diet, just like with constipation. “Fiber can help consolidate and lead to better formed stools. It can help bind up stools as well,” Dr. Poppers explains.
Type 6: Fluffy or Mushy
You have type 6 on the Bristol Stool Chart if your stool is in fluffy pieces with ragged edges. It looks mushy. This type could be caused by a variety of reasons, just like the other types, including recent antibiotic use, medication, dietary changes (lactose intolerance, anyone?), travel, and infectious exposure, Dr. Poppers says. Some conditions can cause it too, like IBS, IBD, and Celiac disease.
Type 7: Entirely Liquid
Finally, the last type on the chart, type 7, is watery stool with no solid pieces, and entirely liquid. This is diarrhea, which could be happening for many reasons, as mentioned in types 5 and 6. Bottom line: If you’re concerned, see your doctor. “In the best-case scenario, it’s just reassurance that things are not concerning, and that’s OK,” Dr. Poppers says. “What I always tell patients is, a lot of what we do is make diagnoses, but we also exclude diagnoses, provide reassurance, and then focus on symptoms and quality of life. And all of that is part of medicine.”
Track Your Poo to Help Determine Your Type
Want to get a better handle on how often you have one type vs. others? Keep a diary, advises Dr. Poppers. Include your diet, exercise, stress level, medications (including antibiotic use), anxiety, sleep changes. Become aware of the things you might not be noticing too, especially while we’re staying at home during the pandemic, he says. Maybe you aren’t moving as much as you once were. Maybe you have new stressors. These can all impact your poo type. By tracking what happens in the bathroom, you’ll have a better handle on any consistent changes you should discuss with your doc.
History of Bristol Stool Chart: The BMJ. (2009). Rapid Response: Bristol Stool Chart and Bristol Stool Form Scale. bmj.com/rapid-response/2011/11/02/bristol-stool-chart-and-bristol-stool-form-scale
Example of Bristol Stool Form Scale Used in Research: Scandinavian Journal of Gastroenterology. (1997). “Stool form scale as a useful guide to intestinal transit time,” pubmed.ncbi.nlm.nih.gov/9299672/
Types of Stool in Chart: Continence Foundation of Australia. (2020). Bristol stool chart. continence.org.au/bristol-stool-chart
Adequate Water Intake: Mayo Clinic. (2020). Water: How much should you drink every day? mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256#:~:text=So%20how%20much%20fluid%20does,fluids%20a%20day%20for%20women
Adequate Fiber Intake: University of California San Francisco. (2020). Increasing Fiber Intake. ucsfhealth.org/education/increasing-fiber-intake#:~:text=The%20American%20Heart%20Association%20Eating,about%20half%20the%20recommended%20amount.
Adequate Daily Exercise: MedlinePlus. (2020). How Much Exercise Do I Need? medlineplus.gov/howmuchexercisedoineed.html#:~:text=Get%2060%20minutes%20or%20more,be%20moderate%2Dintensity%20aerobic%20activity.&text=Also%2C%20try%20to%20get%20each,%2C%20and%20bone%2Dstrengthening%20activity.
COVID-19 GI Symptoms: Centers for Disease Control and Prevention. (2020). Symptom Profiles of a Convenience Sample of Patients with COVID-19 — United States, January–April 2020. cdc.gov/mmwr/volumes/69/wr/mm6928a2.htm#:~:text=Among%20patients%20with%20onset%20before,to%2053%25%20after%20that%20date.