Open main menu

Wikipedia β

Bristol stool scale

Bristol stool chart

The Bristol stool scale, Bristol stool chart (BSC),[1] Bristol stool form scale, or BSF scale[2] is a diagnostic medical tool designed to classify the form of human faeces into seven categories. It is used in both clinical[3] and experimental[4][5] fields. It is sometimes referred to in the UK as the Meyers scale.[6][7]

Developed and proposed for the first time in England by Dr. Stephen Lewis and Dr. Ken Heaton at the University Department of Medicine, Bristol Royal Infirmary, it was suggested by the authors as a clinical assessment tool in 1997 in the journal Scandinavian Journal of Gastroenterology[8] after a previous prospective study, conducted in 1992 on a sample of the population (838 men and 1,059 women), had shown an unexpected prevalence of defecation disorders related to the shape and type of stool.[9] The authors of the former paper concluded that the form of the stool is a useful surrogate measure of colon transit time. That conclusion has since been challenged as having limited validity, and only in types 1 and 2 when the subject is not constipated;[10][ambiguous] however, it remains in use as a research tool to evaluate the effectiveness of treatments for various diseases of the bowel, as well as a clinical communication aid.[11][12]

The Bristol stool scale is part of the diagnostic triad for irritable bowel syndrome: pain/discomfort (quality and quantity), bowel habit (quality and quantity), and bloating (in women).[13]

Contents

Interpretation of the scaleEdit

The seven types of stool are:[14]

  • Type 1: Separate hard lumps, like nuts (hard to pass); also known as goat faeces
  • Type 2: Sausage-shaped, but lumpy
  • Type 3: Like a sausage but with cracks on its surface
  • Type 4: Like a sausage or snake, smooth and soft
  • Type 5: Soft blobs with clear cut edges (passed easily)
  • Type 6: Fluffy pieces with ragged edges, a mushy stool
  • Type 7: Watery, no solid pieces, entirely liquid

Types 1 and 2 indicate constipation, with 3 and 4 being the ideal stools (especially the latter), as they are easy to defecate while not containing excess liquid, and 5, 6 and 7 tending towards diarrhoea.

In the initial study it is interesting to note that, in the population examined in this scale, the type 1 and 2 stools were more prevalent in females, while the type 5 and 6 stools were more prevalent in males; furthermore, 80% of subjects who reported rectal tenesmus (urgency to defecate) had type 7. These and other data have allowed the scale to be validated.[14]

The Bristol stool scale is also very sensitive to changes in intestinal transit time caused by medications, such as antidiarrhoeal loperamide or senna, anthraquinone substance with laxative effect.[15]

VersionsEdit

The same scale is also validated in a Spanish version,[16][17] and a version has also been designed and validated for paediatrics.[18][19] More recently, in September 2011, a modified version of the scale was validated using a criterion of self-assessment for ages 6–8 years of age.[20]

UsesEdit

Diagnosis of IBSEdit

Patients with IBS or irritable bowel syndrome typically report that they suffer with abdominal cramps and constipation. In some patients, chronic constipation is interspersed with brief episodes of diarrhoea; while a minority of patients with IBS have only diarrhoea. The presentation of symptoms is usually months or years and commonly patients consult different doctors, without great success, and doing various specialized investigations. It notices a strong correlation of the reported symptoms with stress; indeed diarrhoeal discharges are associated with emotional phenomena. IBS blood is present only if the disease is associated with haemorrhoids.[21]

Research conducted on irritable bowel syndrome in the 2000s,[22][23] faecal incontinence[24][25][17][26] and the gastrointestinal complications of HIV[27] have used the Bristol scale as a diagnostic tool easy to use; even in research which they lasted for 77 months.[28]

Historically, this scale of assessment of the faeces has been recommended by the consensus group of Kaiser Permanente Medical Care Program (San Diego, California) for the collection of data on functional bowel disease (FBD).[21]

More recently, according to the latest revision of the Rome III Criteria, six clinical manifestations of IBS can be identified:[29][30][31][32][33]

Subtypes prevalent presentation of stool in IBS according to the Rome III Criteria[34]
1. IBS with constipation (IBS-C) - lumpy or hard stools * ≥ 25% and loose (soft) or watery stools † <25% of bowel movements. ‡
2. IBS with diarrhea (IBS-D) - loose (soft) or watery stools † ≥ 25% and lumpy or hard stools * <25% of bowel movements. ‡
3. Mixed IBS (IBS - M) - lumpy or hard stools * ≥ 25% and loose (soft) or watery stools † ≥ 25% of bowel movements. ‡
4. Untyped IBS (IBS - U) - insufficient stool abnormalities to be IBS-C, D or M
* Bristol stool scale type 1-2 (Separate hard lumps like nuts (difficult defecation) or sausage-shaped);

† Bristol stool scale type 6-7 (fluffy pieces with ragged edges, soft or watery, no solid or completely liquid pieces);
‡ In the absence of the use of antidiarrhoeal or laxative.

These four identified subtypes correlate with the consistency of the stool, which can be determined by the Bristol stool scale.[21]

 
Graphical representation of four presentations notes of IBS, and the role of percentage of stool consistency of types 1 and 2 (constipation, ordinate) and of types 6 and 7 (diarrhoea, abscissa) according to the scale of Bristol[35]

In 2007, the Mayo Clinic College of Medicine in Rochester (United States), reported a piece of epidemiological research conducted on a population of 4,196 people living in Olmsted County (Minnesota), in which participants were asked to complete a questionnaire based on the Bristol stool scale.[36]

Distribution of risk factors in three groups classified
according to the colonic transit and subgroups classified according to the type of feces
model century[36]

Normal
colonic transit
(BSS 3-4)
(n=1662)
Slow
colonic transit
(BSS 1-2)
(n=411)
Fast
colonic transit
(BSS 5-7)
(n=197)
Age (mean ± s.d.; years)
62 ± 12
63 ± 13
61 ± 12
Male (%)
50
38
43
BMI (mean ± s.d.)
29,6 ± 7,5
28,2 ± 6,8
32,5 ± 9,9
SSC score (mean ± s.d.) (Somatic Symptom Checklist)
1,6 ± 0,50
1,7 ± 0,53
1,8 ± 0,57
Smoking (%)
8
7
12
Alcohol (%)
45
48
41
Cholecystectomy (%)
11
12
19
Appendectomy (%)
28
31
35
Birth control pills (% women)
3
5
3
Marital status
Married (%)
80
77
76
School level
Compulsory education (%)
5
5
7
High school/some years (%)
53
52
58
Diploma or university (%)
41
42
36
Family history
Gastric cancer (%)
16
14
15
Bowel cancer (%)
12
11
15

The research results (see table) indicate that about 1 in 5 people have a slow transit (type 1 and 2 stools), while 1 in 12 has an accelerated transit (type 5 and 6 stools). Moreover, the nature of the stool is affected by age, sex, body mass index, by cholecystectomy and possible psychosomatic components (somatisation); there were no effects from factors such as smoking, alcohol, the level of education, a history of appendectomy or familiarity with gastrointestinal diseases civil, state, or the use of oral contraceptives.

Therapeutic evaluationEdit

Several investigations correlate the Bristol stool scale in response to medications or therapies, in fact, in one study was also used to titrate the dose more finely than one drug (colestyramine) in subjects with diarrhoea and faecal incontinence.[37]

In a randomised controlled study,[38] the scale is used to study the response to two laxatives: Macrogol (polyethylene glycol) and psyllium (Plantago psyllium and other species of the same genus) of 126 male and female patients for a period of 2 weeks of treatment; failing to show the most rapid response and increased efficiency of the former over the latter. In the study, they were measured as primary outcomes: the number weekly bowel movements, stool consistency according to the types of the Bristol stool scale, time to defecation, the overall effectiveness, the difficulty in defecating and stool consistency.[38]

From 2010, several clinical studies have used the scale as a diagnostic tool validated for recognition and evaluation of response to various treatments, pharmacological and no, different, such as: probiotics,[39][40] moxicombustion,[41] laxatives in the elderly,[42] preparing Ayurvedic poly-phytotherapy filed TLPL/AY,[43] psyllium,[44] mesalazine,[45] methylnaltrexone,[46] and oxycodone/naloxone.[47] Or to assess the response to physical activity in athletes.[48]

ReferencesEdit

  1. ^ Amarenco G (2014). "Bristol Stool Chart: étude prospective et monocentrique de "l’introspection fécale" chez des sujets volontaires" [Bristol Stool Chart: Prospective and monocentric study of 'stools introspection' in healthy subjects]. Progrès en Urologie (in French). 24 (11): 708–13. PMID 25214452. doi:10.1016/j.purol.2014.06.008. 
  2. ^ Gut Sense What Exactly Are Normal Stools?, Konstantin Monastyrsky. Accessed July 2015
  3. ^ Koh, H.; Lee, MJ.; Kim, MJ.; Shin, JI.; Chung, KS. (February 2010). "Simple diagnostic approach to childhood fecal retention using the Leech score and Bristol stool form scale in medical practice". J Gastroenterol Hepatol. 25 (2): 334–8. PMID 19817956. doi:10.1111/j.1440-1746.2009.06015.x. 
  4. ^ Corsetti, M.; De Nardi, P.; Di Pietro, S.; Passaretti, S.; Testoni, PA.; Staudacher, C. (December 2009). "Rectal distensibility and symptoms after stapled and Milligan-Morgan operation for hemorrhoids". J Gastrointest Surg. 13 (12): 2245–51. PMID 19672663. doi:10.1007/s11605-009-0983-7. 
  5. ^ Wang, HJ.; Liang, XM.; Yu, ZL.; Zhou, LY.; Lin, SR.; Geraint, M. (2004). "A Randomised, Controlled Comparison of Low-Dose Polyethylene Glycol 3350 plus Electrolytes with Ispaghula Husk in the Treatment of Adults with Chronic Functional Constipation". Clin Drug Investig. 24 (10): 569–76. PMID 17523718. doi:10.2165/00044011-200424100-00002. 
  6. ^ General Practice Notebook. "Meyers Scale - General Practice Notebook". Retrieved 2015-05-09. 
  7. ^ "Bristol Stool Scale | Stool Forms | Colon Cleanse | Organ Cleansings | Cleanse & Detoxify | Health Science @ Wellness Advantage … … … |". 
  8. ^ Lewis SJ, Heaton KW (September 1997). "Stool form scale as a useful guide to intestinal transit time". Scand. J. Gastroenterol. 32 (9): 920–4. PMID 9299672. doi:10.3109/00365529709011203. 
  9. ^ Heaton, KW.; Radvan, J.; Cripps, H.; Mountford, RA.; Braddon, FE.; Hughes, AO. (June 1992). "Defecation frequency and timing, and stool form in the general population: a prospective study". Gut. 33 (6): 818–24. PMC 1379343 . PMID 1624166. doi:10.1136/gut.33.6.818. 
  10. ^ Rao SS, Camilleri M, Hasler WL, Maurer AH, Parkman HP, Saad R, Scott MS, Simren M, Soffer E, Szarka L (2011). "Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies". Neurogastroenterol Motil. 23 (1): 8–23. PMID 21138500. doi:10.1111/j.1365-2982.2010.01612.x. 
  11. ^ Ackley, Betty J.; Ladwig, Gail B. (2013). Nursing Diagnosis Handbook, An Evidence-Based Guide to Planning Care, 10: Nursing Diagnosis Handbook. Elsevier Health Sciences. p. 240. ISBN 9780323085496. 
  12. ^ Bristol scale stool form. A still valid help in medical practice and clinical research G Riegler, I Esposito – Techniques in coloproctology, 2001 – Springer
  13. ^ National Collaborating Centre for Nursing and Supportive Care, (UK) (February 2008). "Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care, NICE Clinical Guidelines, No. 61". PMID 21656972. Retrieved 17 November 2015. 
  14. ^ a b Mínguez Pérez, M.; Benages Martínez, A. (May 2009). "The Bristol scale - a useful system to assess stool form?". Rev Esp Enferm Dig. 101 (5): 305–11. PMID 19527075. doi:10.4321/s1130-01082009000500001. 
  15. ^ Lewis, SJ.; Heaton, KW. (September 1997). "Stool form scale as a useful guide to intestinal transit time". Scand J Gastroenterol. 32 (9): 920–4. PMID 9299672. doi:10.3109/00365529709011203. 
  16. ^ Parés, D.; Comas, M.; Dorcaratto, D.; Araujo, MI.; Vial, M.; Bohle, B.; Pera, M.; Grande, L. (May 2009). "Adaptation and validation of the Bristol scale stool form translated into the Spanish language among health professionals and patients". Rev Esp Enferm Dig. 101 (5): 312–6. PMID 19527076. doi:10.4321/s1130-01082009000500002. 
  17. ^ a b Maestre, Y.; Parés, D.; Vial, M.; Bohle, B.; Sala, M.; Grande, L. (June 2010). "Prevalence of fecal incontinence and its relationship with bowel habit in patients attended in primary care". Med Clin (Barc). 135 (2): 59–62. PMID 20416902. doi:10.1016/j.medcli.2010.01.031. 
  18. ^ Chumpitazi, BP.; Lane, MM.; Czyzewski, DI.; Weidler, EM.; Swank, PR.; Shulman, RJ. (October 2010). "Creation and initial evaluation of a stool form scale for children". J Pediatr. 157 (4): 594–7. PMC 2937014 . PMID 20826285. doi:10.1016/j.jpeds.2010.04.040. 
  19. ^ Candy, D.; Paul, S. "Go with the flow: in childhood constipation". J Fam Health Care. 21 (5): 35, 37–8, 40–1 passim. PMID 22132564. 
  20. ^ Lane, MM.; Czyzewski, DI.; Chumpitazi, BP.; Shulman, RJ. (September 2011). "Reliability and validity of a modified Bristol Stool Form Scale for children". J Pediatr. 159 (3): 437–441.e1. PMC 3741451 . PMID 21489557. doi:10.1016/j.jpeds.2011.03.002. 
  21. ^ a b c Longstreth, GF.; Thompson, WG.; Chey, WD.; Houghton, LA.; Mearin, F.; Spiller, RC. (April 2006). "Functional bowel disorders". Gastroenterology. 130 (5): 1480–91. PMID 16678561. doi:10.1053/j.gastro.2005.11.061. 
  22. ^ Yilmaz, S.; Dursun, M.; Ertem, M.; Canoruc, F.; Turhanoğlu, A. (March 2005). "The epidemiological aspects of irritable bowel syndrome in Southeastern Anatolia: a stratified randomised community-based study". Int J Clin Pract. 59 (3): 361–9. PMID 15857337. doi:10.1111/j.1742-1241.2004.00377.x. 
  23. ^ Adibi, P.; Behzad, E.; Pirzadeh, S.; Mohseni, M. (August 2007). "Bowel habit reference values and abnormalities in young Iranian healthy adults". Dig Dis Sci. 52 (8): 1810–3. PMID 17410463. doi:10.1007/s10620-006-9509-2. 
  24. ^ Macmillan, AK.; Merrie, AE.; Marshall, RJ.; Parry, BR. (October 2008). "Design and validation of a comprehensive fecal incontinence questionnaire". Dis Colon Rectum. 51 (10): 1502–22. PMID 18626716. doi:10.1007/s10350-008-9301-9. 
  25. ^ Chung, JM.; Lee, SD.; Kang, DI.; Kwon, DD.; Kim, KS.; Kim, SY.; Kim, HG.; Moon, du G.; Park, KH.; Park, YH.; Pai, KS. (July 2010). "An epidemiologic study of voiding and bowel habits in Korean children: a nationwide multicenter study". Urology. 76 (1): 215–9. PMID 20163840. doi:10.1016/j.urology.2009.12.022. 
  26. ^ El-Gazzaz, G.; Zutshi, M.; Salcedo, L.; Hammel, J.; Rackley, R.; Hull, T. (December 2009). "Sacral neuromodulation for the treatment of fecal incontinence and urinary incontinence in female patients: long-term follow-up". Int J Colorectal Dis. 24 (12): 1377–81. PMID 19488765. doi:10.1007/s00384-009-0745-8. 
  27. ^ Tinmouth, J.; Tomlinson, G.; Kandel, G.; Walmsley, S.; Steinhart, HA.; Glazier, R. "Evaluation of Stool frequency and stool form as measures of HIV-related diarrhea". HIV Clin Trials. 8 (6): 421–8. PMID 18042507. doi:10.1310/hct0806-421. 
  28. ^ Zutshi, M.; Tracey, TH.; Bast, J.; Halverson, A.; Na, J. (June 2009). "Ten-year outcome after anal sphincter repair for fecal incontinence". Dis Colon Rectum. 52 (6): 1089–94. PMID 19581851. doi:10.1007/DCR.0b013e3181a0a79c. 
  29. ^ Park, JM.; Choi, MG.; Cho, YK.; Lee, IS.; Kim, JI.; Kim, SW.; Chung, IS. (July 2011). "Functional Gastrointestinal Disorders Diagnosed by Rome III Questionnaire in Korea". J Neurogastroenterol Motil. 17 (3): 279–86. PMC 3155064 . PMID 21860820. doi:10.5056/jnm.2011.17.3.279. 
  30. ^ Dong, YY.; Zuo, XL.; Li, CQ.; Yu, YB.; Zhao, QJ.; Li, YQ. (September 2010). "Prevalence of irritable bowel syndrome in Chinese college and university students assessed using Rome III criteria". World J Gastroenterol. 16 (33): 4221–6. PMC 2932929 . PMID 20806442. doi:10.3748/wjg.v16.i33.4221. 
  31. ^ Sorouri, M.; Pourhoseingholi, MA.; Vahedi, M.; Safaee, A.; Moghimi-Dehkordi, B.; Pourhoseingholi, A.; Habibi, M.; Zali, MR. "Functional bowel disorders in Iranian population using Rome III criteria". Saudi J Gastroenterol. 16 (3): 154–60. PMC 3003223 . PMID 20616409. doi:10.4103/1319-3767.65183. 
  32. ^ Miwa, H. (2008). "Prevalence of irritable bowel syndrome in Japan: Internet survey using Rome III criteria". Patient Prefer Adherence. 2: 143–7. PMC 2770425 . PMID 19920955. 
  33. ^ Engsbro, AL.; Simren, M.; Bytzer, P. (February 2012). "Short-term stability of subtypes in the irritable bowel syndrome: prospective evaluation using the Rome III classification". Aliment Pharmacol Ther. 35 (3): 350–9. PMID 22176384. doi:10.1111/j.1365-2036.2011.04948.x. 
  34. ^ "Medscape Log In". 
  35. ^ "IBS, Irritable Bowel Syndrome". 
  36. ^ a b Choung, RS.; Locke, GR.; Zinsmeister, AR.; Schleck, CD.; Talley, NJ. (October 2007). "Epidemiology of slow and fast colonic transit using a scale of stool form in a community". Aliment Pharmacol Ther. 26 (7): 1043–50. PMID 17877511. doi:10.1111/j.1365-2036.2007.03456.x. 
  37. ^ Remes-Troche, JM.; Ozturk, R.; Philips, C.; Stessman, M.; Rao, SS. (February 2008). "Cholestyramine--a useful adjunct for the treatment of patients with fecal incontinence". Int J Colorectal Dis. 23 (2): 189–94. PMID 17938939. doi:10.1007/s00384-007-0391-y. 
  38. ^ a b Wang, HJ.; Liang, XM.; Yu, ZL.; Zhou, LY.; Lin, SR.; Geraint, M. (2004). "A Randomised, Controlled Comparison of Low-Dose Polyethylene Glycol 3350 plus Electrolytes with Ispaghula Husk in the Treatment of Adults with Chronic Functional Constipation". Clin Drug Investig. 24 (10): 569–76. PMID 17523718. doi:10.2165/00044011-200424100-00002. 
  39. ^ Sakai, T.; Makino, H.; Ishikawa, E.; Oishi, K.; Kushiro, A. (June 2011). "Fermented milk containing Lactobacillus casei strain Shirota reduces incidence of hard or lumpy stools in healthy population". Int J Food Sci Nutr. 62 (4): 423–30. PMID 21322768. doi:10.3109/09637486.2010.542408. 
  40. ^ Riezzo, G.; Orlando, A.; D'Attoma, B.; Guerra, V.; Valerio, F.; Lavermicocca, P.; De Candia, S. (February 2012). "Randomised clinical trial: efficacy of Lactobacillus paracasei-enriched artichokes in the treatment of patients with functional constipation - a double-blind, controlled, crossover study". Aliment Pharmacol Ther. 35 (4): 441–50. PMID 22225544. doi:10.1111/j.1365-2036.2011.04970.x. 
  41. ^ Park, JE.; Sul, JU.; Kang, K.; Shin, BC.; Hong, KE.; Choi, SM. (2011). "The effectiveness of moxibustion for the treatment of functional constipation: a randomized, sham-controlled, patient blinded, pilot clinical trial". BMC Complement Altern Med. 11: 124. PMC 3248868 . PMID 22132755. doi:10.1186/1472-6882-11-124. 
  42. ^ Fosnes, GS.; Lydersen, S.; Farup, PG. (2011). "Effectiveness of laxatives in elderly--a cross sectional study in nursing homes". BMC Geriatr. 11: 76. PMC 3226585 . PMID 22093137. doi:10.1186/1471-2318-11-76. 
  43. ^ Munshi, R.; Bhalerao, S.; Rathi, P.; Kuber, VV.; Nipanikar, SU.; Kadbhane, KP. (July 2011). "An open-label, prospective clinical study to evaluate the efficacy and safety of TLPL/AY/01/2008 in the management of functional constipation". J Ayurveda Integr Med. 2 (3): 144–52. PMC 3193686 . PMID 22022157. doi:10.4103/0975-9476.85554. 
  44. ^ Pucciani, F.; Raggioli, M.; Ringressi, MN. (December 2011). "Usefulness of psyllium in rehabilitation of obstructed defecation". Tech Coloproctol. 15 (4): 377–83. PMID 21779973. doi:10.1007/s10151-011-0722-4. 
  45. ^ Bafutto, M.; Almeida, JR.; Leite, NV.; Oliveira, EC.; Gabriel-Neto, S.; Rezende-Filho, J. "Treatment of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with mesalazine". Arq Gastroenterol. 48 (1): 36–40. PMID 21537540. doi:10.1590/s0004-28032011000100008. 
  46. ^ Michna, E.; Blonsky, ER.; Schulman, S.; Tzanis, E.; Manley, A.; Zhang, H.; Iyer, S.; Randazzo, B. (May 2011). "Subcutaneous methylnaltrexone for treatment of opioid-induced constipation in patients with chronic, nonmalignant pain: a randomized controlled study.". J Pain. 12 (5): 554–62. PMID 21429809. doi:10.1016/j.jpain.2010.11.008. 
  47. ^ Clemens, KE.; Quednau, I.; Klaschik, E. (April 2011). "Bowel function during pain therapy with oxycodone/naloxone prolonged-release tablets in patients with advanced cancer". Int J Clin Pract. 65 (4): 472–8. PMID 21401835. doi:10.1111/j.1742-1241.2011.02634.x. 
  48. ^ Strid, H.; Simrén, M.; Störsrud, S.; Stotzer, PO.; Sadik, R. (June 2011). "Effect of heavy exercise on gastrointestinal transit in endurance athletes". Scand J Gastroenterol. 46 (6): 673–7. PMID 21366388. doi:10.3109/00365521.2011.558110. 

BibliographyEdit

See alsoEdit