The Scoop On Poop

It's a fact: everybody poops. Although the subject isn't usually considered an appropriate topic of conversation, if you're having a poop problem, it's important to be able to talk about it.

The primary concern most people have is whether their poop is "normal." Surprisingly, there's a huge variation in what constitutes a "normal" poop. Two healthy family members could share the same household and eat the same food and still have great discrepancies in their bowel movements.

The Bristol Stool Form Score, also known as the Bristol Stool Chart and Bristol Stool Scale, is a medical aid that categorizes human feces into seven types. Created by Kenneth Heaton, MD, it was developed as a visual aid for the doctor-patient relationship to distinguish normal stools from abnormal ones and be able to discuss them without feeling embarrassed. It is also used as a tool to determine the success of bowel-related treatments. 
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Stool consistency and appearance will change somewhat, day to day and movement to movement, depending on a number of factors, including what a person has eaten. Looking at the chart, however, it's still difficult to know what's "normal" for healthy individuals and when to be concerned.

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 DON'T WORRY IF . . .

• ​you don't have a daily bowel movement, as long as the stool is comfortable and easy to pass when you do;
• your stools are lumpy (types 1 or 2 on the Bristol Scale), as long as they're comfortable and easy to pass;
• your stools seem a bit "loose" (types 6 or 7 on the Bristol Scale), as long as you have no other concerning symptoms and don't have a sense of urgency to reach the bathroom.

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CONTACT YOUR DOCTOR IF . . .

• your stool is continually hard, painful, and difficult to pass;
• your stool is continually very loose or watery;
• you have ongoing pain when passing stool;
• you often need to rush to the bathroom to avoid having an accident;
• you notice blood in your stool;
• your stool is tarry or black;
• you have any other ongoing concerns about your bowel movements or symptoms.

With irritable bowel syndrome (IBS), bowel habits suddenly become erratic and unpredictable and are accompanied by significant abdominal pain. Because there are many possible causes (other than IBS) for why bowel habits suddenly alter or there's pain with defecation, it's vital to not self-diagnose your condition.

According to the Rome IV diagnostic criteria, there are a variety of IBS subtypes, depending on whether constipation, diarrhea, neither, or both is the predominant symptom.

Constipation predominant IBS (IBS-C)
More than 1 in 4 bowel movements is Bristol stool type 1 or 2 (small, hard, and difficult to pass), and fewer than 1 in 4 stools is classified as type 6 or 7 (watery, mushy).

Diarrhea predominant IBS (IBS-D)
More than 1 in 4 bowel movements is Bristol stool type 6 or 7 (watery, mushy), and fewer than 1 in 4 stools is classified as type 1 or 2 (small, hard, and difficult to pass).

IBS Mixed (IBS-M)
More than 1 in 4 bowel movements with Bristol stool type 1 or 2 (small, hard and difficult to pass), and more than 1 in 4 bowel movements with Bristol stool type 6 or 7 (watery, mushy).

IBS Unclassified (IBS-U)
Patients meet other diagnostic criteria for IBS, but their bowel habits don't fit any of the above IBS classifications.

A low-FODMAP diet has been shown to help improve the symptoms of many IBS sufferers, and it may also improve the quality of bowel movements. However, because there currently is no cure for IBS, and because altered bowel habits are a defining characteristic of the syndrome, it's unrealistic to expect bowel movements to return to how they were prior to IBS, even if other symptoms have improved or greatly subsided.

The takeaway? Don't worry about your poop if your other symptoms have improved. Doing so will only create unnecessary anxiety, which in turn can trigger or exacerbate your symptoms and unravel your progress. 

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