Stools and Your Health -- Output matters (THE BRISTOL STOOL SCALE) - Bowel Movement

Depending on whether your stools are hard and lumpy like nuts, or sausage shaped and smooth, a gastroenterologist can tell the state of your health. STACEY CHIA reports

What's your type? A psychologist may 'look' into your head to gauge if you are a highly driven Type A or have a relaxed Type B personality.

A gastroenterologist will get straight to the bottom of the matter by looking at your stool type which can give an idea of the state of your health.

There is even a seven-point visual indicator - the Bristol Stool Scale - to tell how long your stool has been in your colon, and what it can mean.

The seven types on the scale, named after the British university that came up with it, are:

THE BRISTOL STOOL SCALE:

Type 1 - Separate hard lumps, like nuts
Type 2 - Sausage-shaped and lumpy
Type 3 - Sausage-shaped with cracks
Type 4 - Sausage-shaped, smooth and soft
Type 5 - Soft blobs, passed out easily
Type 6 - Fluffy pieces and mushy
Type 7 - Watery with no solid pieces

Types 1 and 2 are considered constipated, while 6 and 7 are under the diarrhoea group; the normal stools are those that fall under types 3, 4 and 5.

Dr Yap Chin Kong from Yap Chin Kong Gastroenterology & Liver Clinic said the scale is useful in that it indicates stool 'transit time'. A long transit time implies constipation and a short transit time, diarrhoea.

Transit time is the time stool stays in the colon before it is passed out.

'Types 1 and 2 are considered constipated, while 6 and 7 are under the diarrhoea group; the normal stools are those that fall under types 3, 4 and 5,' he said.

Dr Gwee Kok Ann, consultant gastroenterologist at Gleneagles Hospital, said Type 1 stool has a transit time of over 72 hours or longer, while Type 4 - the ideal - is most easily expelled, with a transit time of 24 hours.

Dr Yap added that the usual frequency of stool being passed out ranges from three times a day to once every three days.

While most people only 'go' when they feel the urge, he believes that people should develop good toilet habit from childhood.

This means waking up early, having breakfast, then waiting for the urge to move the bowels. This will usually occur within 30 minutes to an hour for many people.

Regular exercise and eating sufficient fruits and vegetables can help in developing good toilet habit.

'Someone who gets up late and rushes off to school or work after eating breakfast quickly may develop the urge but postpone nature's call or not even have the urge because the mind overrides it,' said Dr Yap.

Not moving the bowels regularly may lead to complications for the young and very old, Dr Gwee said. A large mass of stool stuck in the rectum can cause it to overstretch.

'When this happens, the muscle in the rectum's wall loses its tone. There will then be difficulty contracting the muscle to evacuate the contents. This usually affects young children and the elderly,' he added.

He said that, should this happen, it can give rise to abdominal cramps and vomiting in children.
'As for some elderly patients, stool pellets may actually spill out without their being aware, while others may develop ulcers in the rectum arising from the pressure placed on the wall of the rectum by very hard stools,' he said.

For the layman, the scale comes in handy in noting changes in bowel patterns.

'If you have experienced a recent change in your bowel pattern without a clear reason, or if there are alarming signs such as blood, pain or fever, you should see a doctor,' said Dr Yap.

However, some doctors like Dr Tan Chi Chiu, consultant gastroenterologist and physician at Gastroenterology & Medicine International, cautioned against over-reliance on the scale as a precise gauge of transit time.

'It is not precise. Different people have different grades of stool for similar transit times,' he explained.

Source: Mind Your Body of The Straits Times dated 30 July 2008