Bristol Chair Shape Scale for IBD
Few topics are as taboo as our own bowel movements, yet they often tell us more about our health than we think. What we leave in the toilet every day or sometimes only every few days consists largely of water, plus undigested food residue, shed mucosal cells, bacteria and some mucus from the bowel. All of this can look very different depending on diet, fluid intake, exercise and state of health. As changes in the consistency, quantity or frequency of bowel movements can provide information about various diseases, it is important to be aware of these and discuss them with your doctor.
The Bristol Stool Form Scale was developed to make it easier to classify your own bowel movements and thus improve the diagnosis of gastrointestinal problems. It categorizes stools into seven types, from very solid to completely liquid. This scale can be a valuable tool, especially for those affected by chronic inflammatory bowel disease, to share specific observations with the gastroenterologist treating them.
- Bristol Chair Shape Scale for IBD
- What is the Bristol chair shape scale?
- What types does the Bristol chair shape scale divide the chair into?
- What are the advantages of the Bristol chair shape scale?
- What are the limitations of the Bristol chair shape scale?
- What comparable scales are there?
- Conclusion
- Other interesting articles
What is the Bristol chair shape scale?
The Bristol Stool Shape Scale (BSS) was developed at the eponymous University of Bristol by the British scientists Heaton and Lewis and serves as a clinical assessment scheme for human stool. The aim was to create a simple and visually understandable method that facilitates communication between doctors and patients. The scale evaluates the shape and consistency of the stool based on seven different stool types, making it possible to see whether the stool is within the healthy range or whether there are any noticeable deviations. The scale also provides information on the duration of the intestinal passage and can thus allow conclusions to be drawn about possible disorders or diseases of the digestive tract.
What types does the Bristol chair shape scale divide the chair into?
The Bristol Stool Form Scale basically divides stool into seven different types. While type 1 can remain in the intestine for up to 100 hours, type 7 only remains in the human body for around ten hours. The seven stool types can be described as follows.
Single, solid, difficult to excrete globules
Lumpy sausages
Sausage-like with a cracked surface
Sausage-shaped with a smooth surface
Soft, easy-to-extract lumps with smooth edges
Single, soft, mushy lumps with irregular edges
Liquid, without solid components
Types one and two indicate a slow transit time through the intestine and therefore constipation. This can be caused by impaired intestinal flora, too little fluid or a lack of fiber, among other things. Types three to five are desirable stool forms and indicate a well-functioning digestive system. Type four in particular, sausage-shaped with a smooth surface, is considered optimal. Types six and seven indicate rapid bowel movement. Repeated diarrhea should be observed, as this can lead to loss of fluids and nutrients and may indicate problems with intestinal health.
What are the advantages of the Bristol chair shape scale?
The Bristol Stool Shape Scale helps people with IBD to document and assess changes in their bowel movements. The advantage is that it is easy to understand and allows both patients and doctors to clearly describe the consistency and shape of the stool without special training. This allows changes to be discussed precisely, the course of treatment to be monitored and potential disease relapses to be recognized at an early stage.
What are the limitations of the Bristol chair shape scale?
Although the Bristol Chair Shape Scale is a practical tool for chair assessment, there are a few limitations to consider. On the one hand, the assessment can be subjective, so different people may categorize the same chair differently. On the other hand, although the scale provides data on the shape and consistency of the stool, it does not provide information on other important characteristics such as frequency, color or odor of the stool. Therefore, the scale alone is not sufficient to diagnose complex bowel diseases and should always be used in conjunction with further examinations and medical advice.
What comparable scales are there?
For children, there is the so-called Modified Bristol Stool Form Scale for Children. This is an adapted version of the scale, which comprises only five categories instead of seven and is intended to make classification easier for children. There are also other scales for Crohn's disease and ulcerative colitis that assess disease activity. The Harvey-Bradshaw Index, which is mainly used for Crohn's disease, asks, for example, about the number of unformed bowel movements per day, general well-being and possible abdominal pain. In ulcerative colitis, on the other hand, the Simple Clinical Colitis Activity Index (SCCAI) is used, for example, which includes the frequency of bowel movements per day, rectal blood discharge and general state of health in the assessment of disease activity.
Conclusion
The Bristol Stool Form Scale is a simple but extremely useful tool for classifying your own bowel movements and thus recognizing changes at an early stage. Despite its limitations, such as the purely subjective assessment or the focus on shape and consistency, it provides an important basis for self-observation and joint discussions with doctors, especially for people with chronic inflammatory bowel disease. Although the scale alone is not sufficient to diagnose complex bowel diseases, it can be a valuable component of disease management in combination with other examinations. Our IBD app, which was specially developed for IBD sufferers, also uses the Bristol Stool Form Scale to provide more clarity about the course of the disease.
CED-despite-me. It's the poo that counts - tips for recognizing healthy bowel movements. CED-despite-me. https://www.ced-trotzdem-ich.de/unterstuetzung-erhalten/news/gesunden-stuhlgang-erkennen
Dr. Nicole Steenfatt. Bristol chair shape scale. Intestinal health practice. https://darmgesundheitspraxisdrsteenfatt.de/bristol-stuhlformen-skala/
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Knapp, A. (2021, March 27). Chair scale for children and adolescents. aylineknapp. https://aylinknapp.com/aylin-klaert-auf/bristol-skala-stuhlformen-skala-verstopfung-kinder-und-jugendliche/
Koletzko, S., Otte, S. & Klucker, E. Stool tests in pediatric gastroenterology. Monatsschr Kinderheilkd 165, 572-580 (2017). https://doi.org/10.1007/s00112-017-0316-y
Mediscope (2010, January 01). Clinical scores. Mediscope. https://www.gastro.medline.ch/Services/_Tools/Klinische_Scores/Klinische_Scores_Gastroenterologie_Diagnose_Aktivitaet_Prognose.php
Wäsche, S. (2024, August 08). Bristol chair shape scale. Pflegerio. https://www.pflegerio.de/diagnostik/bristol-stuhlformen-skala/
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