The Doo-Doo Documents 2: The Bristol Form Stool Scale

The Bristol stool scale was developed at the Bristol Royal Infirmary in 1997 and is based on the poops of approximately 2,000 people. Developed by Dr. Ken Heaton, this scale makes it a little easier for people to discuss what comes out the other end.

One way of looking at this scale is to think about how much water is in each type of poop. 1 & 2 are very dry and may be seen when one is constipated. 6 & 7 are considered diarrhea — plenty of water in these poops. #4 is Goldilocks (Goldilogs?!) and 3 & 5 are either side of “just right” and considered pretty good. NOTE: if you consistently pass either the hard poops or the mushy poops, OR, if you switch back and forth between the two, then you may want to speak with a physician.

Let’s talk about how these poops come about. For this information, I’m going to rely primarily on Gut: The Inside Story of our Body’s Most Underrated Organ by Giulia Enders* (2015). (Sometimes word for word and sometimes paraphrased. Rest assured, all this technical info is coming from here, unless otherwise mentioned.)
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Poops are 3/4 water. 1/3 of the solids are bacteria. Another 1/3 is indigestible vegetable fiber. (The more fruit and veg you eat, the more feces you excrete per bowel movement.) The last 1/3 is stuff your body wants out: remains of medicines, food coloring or cholesterol.

Enders says the type of poop can indicate how long it takes for the indigestible particles to pass through one’s gut. With this in mind, she says Type 1, the rabbit pellets — the hard, little lumps — can take around 100 hours to pass through the system. On the other end, Type 7 — the diarrhea — can whiz through in 10 hours (or less!). Let me add here that Lewis and Heaton (1997) found the Bristol Stool Scale is a useful guide to intestinal transit time.

If you are in the envied position of regularly doing 3s and 4s, Enders says to make sure to observe how quickly they sink. If they sink too quickly it may indicate they still contain nutrients that weren’t digested properly.

Kate Deering, author of How to Heal Your Metabolism (2015) describes a healthy feces as "firm, about 6-8 inches in length and about an inch in diameter." She continues: "If you are having a hard time eliminating you may be dehydrated and need to add in more minerals (primarily salt), fruit and water-containing foods to your diet."

How long should it take to poop?

That’s a trickier question than it first appears to be.

Soft Matter journal (Yang et al. 2017) says the average mammal — regardless of size — takes just 12 seconds to poop.

According to Mayo Clinic (Rajan 2019), it takes about 6-8 hours for food to pass through the stomach and small intestine. Then it moves into the large intestine for further digestion, absorption of water … taking about 36 hours to get all the way through the system.

Dr. Sonpal (Migala 2020) says it should take no more than 5-10 minutes to complete a poop with “minimal straining.”

What’s the best way to get the poop out?

Back to Gut again, an Israeli doctor, Dov Sikirov, had 28 test subjects poop in three different positions (normal toilet, half sit/half squat on a low toilet and squatting without a seat) and recorded how long they each took and recorded how much straining each position required: “The results were clear. In a squatting position, the subjects took an average of 50 seconds and reported a feeling of full, satisfaction bowel emptying. The average time when seated was 130 seconds and the resulting feeling was deemed to be not quite so satisfactory.”

Japanese researchers wanted a bit more assurance and they actually fed their volunteers “luminous substances” and x-rayed them while pooping in various positions. Again from Gut, “squatting does indeed lead to a nice, straight intestinal tract, allowing for a direct, easy exit.”

Long story short here: if you have problems getting the poop out, try a squatting stool* (Do a quick search for “squat” and “toilet” and see the options available.)

OK, back to the Bristol Stool Scale…

NOTE: If you experience the following symptoms during bowel movements (pain, blood, excessive mucus), especially if they are ongoing, or, if you have recently had a change in bowel habits, be sure to seek professional medical advice.

Homeopathy is all about balancing the entire system. The best way to do this is with a full consultation with a professional homeopath who is taking all sorts of everything into consideration. With that in mind, a good stool remedy is a good stool remedy. Bryonia may be my go-to remedy to think about for constipation (a “3” in Murphy’s repertory), but it’s also listed under the opposite: forcible, sudden, gushing, but this time it is a “1”. I am putting out a few remedies to consider for various stool issues, but don’t lock yourself into a hard-line of thinking here — there is flexibility. Don’t get stuck into, “but Bryonia is a dry poop remedy” way of thinking — Bryonia can be a good remedy for stools, in general.

Type 1: also known as rabbit droppings. I have known young mothers who didn’t mind when their little ones had these — they could skip the diaper change and literally just pull the little pellets out of the diaper and carry on with the day. Easy? I suppose so. But if your little one is popping out this kind of poop, there might be some dehydration issues going on. Seriously. Don’t take this as normal.

Homeopathically, we could look at rubrics such as: Stool, Balls, Stools like; or, like small balls; or, like laurel berries. There are lots of good remedies listed for this, but I would start with Alumina, Bryonia, Nat mur or Plumbum. (Can I just say how much I love the name Plumbum? It’s Latin for lead and I think it’s just perfect — it’s helpful for plumbing the bum and getting the lead out when one is all bunged up 🤣.)

Dry stool is an even bigger rubric with a lot of the above-repeating rubrics. However, I would start with Bryonia or Nux vomica. If it’s a dry and crumbling stool, Alumina. If it’s a dry stool which kind of starts and stops and then recedes, start with Silica.

Type 2: still dry, but this time the pebbles have been fused together. For this one, all of the above dry stool remedies are worth considering, but I would probably start with Nux vomica. If it’s a lumpy stool covered with mucus**, start with Alumina. A dry and crumbling stool, Alumina or Nat mur. A lovely rubric: Stool, Sheep, dung, like - agglutinated, masses of: Plumbum.

Type 3: is a little tougher to distinguish, homeopathically speaking. 3 is moving toward the “Goldilog” so perhaps just a little more fluid in your diet should do the trick?

Type 4: smooth sailing — keep up the good work!

Type 5: the pediatric Bristol Stool Form Scale describes this as “chicken nuggets” — soft blobs with clear-cut edges (passed easily). Like Type 3, I think we’re hovering around “good to go” — there may not be an issue here that needs to be addressed.

Type 6: A mushy stool — not formed. If it looks like corn meal: Bryonia. Other remedies to consider: Rhus tox and Podophyllum. If it’s an involuntary soft stool, start with Aloe.

Type 7: entirely liquid — now we’re moving into total diarrhea territory and there are many, many remedies to address this. I will be writing more in-depth about diarrhea shortly, but for today, let’s just start with Arsenicum album, China officinalis or Phosphoric acid.

Once again, if your regular stool is not hovering around 3, 4, and 5, please seek a professional medical opinion.

Don’t forget to check out the deposits you make into the porcelain bank! Any regular stools on either end of this scale should be evaluated by a medical professional.


Julia Coyte, CHom
Classically Practical homeopath


#wellnessawaits


* I have no affiliation with this book, I just really like it — very fun and highly readable!

** (Note: A small amount of mucus on the stool is usually not a cause for concern. Mucus lines your intestines to keep your colon running smoothly, among other tasks. However, if there is excessive mucus in or on the stool it may be a sign of an underlying condition such as: Irritable Bowel Syndrome, Inflammatory Bowel Disease, Crohn’s Disease, Ulcerative Colitis, food poisoning, bowel obstruction or blockage, cancer of the rectum or colon. If you have excessive mucus or even a small amount of mucus which is on-going, seek professional medical advice, especially if it is accompanied by abdominal pain, bloody stools, fever or weight loss (Mayo Clinic). Check out this article for more information.)

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REFERENCES:

Deering, K., 2015. How to heal your metabolism : stop blaming aging for your slowing metabolism! : learn how the right foods, sleep, the right amount of exercise, and happiness can increase your metabolic rate and help heal your broken metabolism. United States: Createspace Independent Publishing Platform.

Enders, G., 2015. Gut : the Inside Story of Our Body’s Most Underrated Organ. Greystone Books.

Lewis, S. J. and Heaton, K. W. (1997) ‘Stool Form Scale as a Useful Guide to Intestinal Transit Time’, Scandinavian Journal of Gastroenterology, 32(9), pp. 920–924. 

Migala, J., 2020. How Long It Should Take to Have a Healthy Poop, According to Gastroenterologists [online]. Livestrong.com. 

Yang, P. J., LaMarca, M., Kaminski, C., Chu, D. I. and Hu, D. L., 2017. Hydrodynamics of defecation. Soft Matter, 13 (29), 4960–4970.