Very few of us (especially women!) want to talk poop – in fact, you may not even want to pay attention to your own poop, flushing quickly after each bowel movement. However, it’s important to remember that there’s a lot of information to gleam from what’s going on back there. So, what do you need to know so you can tell what your poop is trying to tell you at a glance?
In this article, we’ll be looking at the Bristol Stool Chart and what it represents. We’ll also be examining what your poop should look like and when to seek medical help if something changes.
The Bristol Stool Chart
Unless you’re a nurse or doctor, you likely won’t have heard of the Bristol Stool Chart. Simply put, this is a chart that illustrates the 7 different types of stool. Let’s break it down, looking at what types of stool there are and what they indicate is going on inside the body:
1-2: The first two images show small, hard stools and indicate constipation. If the stool looks more like sheep or rabbit poop, the patient likely has severe constipation.
3-4: Three to four is considered normal and should look like a sausage shape, either smooth or with cracks in the surface.
5-6: Images five and six show extremely loose or watery stool and suggest that a patient lacks fiber or has mild diarrhea.
7: Image 7 is of liquid poop that is considered full or even severe diarrhea.
When I show this chart to my patients, they tend to have a very strong reaction because poop is not an enjoyable thing to discuss, and many of us have been brought up to feel embarrassed about what goes on behind the bathroom door. But this chart is helpful as it gives me an idea of what's going on in their gut.
How often should I go to the bathroom?
There is no right or wrong number of times you should poop, although most people go anywhere between twice a day and three times a week. Most people have something or a routine or pattern, meaning they go to the bathroom around the same number of times a day and at the same time each day. Generally, you shouldn’t be trying to schedule your time in the bathroom and forcing yourself to go at a certain time of day. Straining is unnatural and can lead to problems, so try to let your body tell you when it’s time to go.
What affects my poop?
The regularity of your toilet breaks can be affected by four main elements:
Age: The older people get, the more likely they are to experience constipation. This issue is caused by things like reduced mobility, a reduced gastric movement that normally promotes digestion, and medication that can hinder bowel health.
Diet: The best way to promote regular bowel movements is to eat soluble and insoluble fiber in the form of fruit, vegetables, and whole grains. If a patient’s diet is low in fibrous foods, they may not go to the bathroom as regularly.
It’s also worth noting a patient’s hydration level is also a factor, as fluids also soften stool, making it easier to pass. For this reason, I recommend increasing fluid intake if a patient is constipated.
Activity level: One of the easiest ways to promote regular bowel movement is to engage in some physical activity like walking or cycling. Such activity promotes peristalsis, which is the intestinal movement that pushes digested food forward so that it can be excreted.
Physical health: Some chronic illnesses like Crohn’s disease and ulcerative colitis can cause diarrhea followed by periods of constipation. Changes in bowel movements can also be affected by acute illnesses like stomach flu or injuries that require patients to take pain medication that delays bowel activity.
What should my poop look like? What is normal?
In terms of normal bowel movements, the consistency of your poop can be as important as its frequency. As we saw earlier, stools should be fairly soft and pass with ease. The “typical” stool often resembles a sausage or snake, which mirrors the inside of the intestines, as you can see in image 3 and 4 of the Bristol Stool Chart.
As for color, stools should generally be a medium brown, though some changes in diet (such as eating a lot of beetroot) can alter the color, and aren’t cause for concern.
If a patient’s stools are loose or watery, they may be experiencing some digestive irritation. This watery consistency comes from the feces traveling through their intestines too quickly to become bulky. Such an issue may cause problems because the patient will need to go to the toilet more often, meaning their body won’t absorb as many nutrients as it should.
On the other hand, constipation can be just as uncomfortable. Hard stools often cause difficulties going to the bathroom which may cause hemorrhoids and lead to stool backing up in the intestines.
If you’re experiencing constipation, I’ll be speaking about it in my next article, which you can read here.
When should I speak to my doctor about unusual bowel movements?
Whether you’ve been unwell or made changes to your diet, it’s common to experience a change in your bowel movements every so often. But if these changes last over a week, you may want to speak with your doctor.
Here are some symptoms that suggest you may need to seek medical attention.
blood in your stool (this may be red or black and look similar to coffee grounds)
no bowel movement in over three days
watery diarrhea for more than a day or two
diarrhea with a loss of appetite for more than a day or two
any sharp, stabbing pains in the lower abdomen
If you regularly experience constipation or diarrhea or have general issues passing stool, you should speak to your doctor. They’ll probably ask you for a medical history and look at any medication you’re on to establish if any of them could be contributing to your bathroom issues. If you’re unsure which changes to implement, your doctor can also recommend dietary and general lifestyle changes to encourage bowel regularity.
Dr. Nancy Rahnama, MD, ABOM, ABIM, is a medical doctor board certified by both the American Board of Obesity Medicine and the American Board of Internal Medicine. Her specialty is Clinical Nutrition, that is, the use of nutrition by a medical doctor to diagnose and treat disease. Dr. Rahnama has helped thousands of people achieve their goals of weight loss, gut health, improved mood and sleep, and managing chronic disease.