Using the Bristol Stool Chart to Evaluate Bowel Movements

We all do it, but nobody wants to talk about it! 

Your bowel movements are one of the most visible indicators of health and function. It’s free information; all you have to do is brave the smell for a moment, and gaze into the toilet after doing the deed. 

To keep your bowel movements healthy, make sure that you stay properly hydrated and enjoy your non-starchy vegetables, nuts, and seeds that provide fiber. 

You may find your bowel movements are different on a low-carbohydrate diet, for example they may be less frequent and less painful. 

This advice is intended to inform and help you. If you’ve been having very abnormal bowel movements for some time, you may be familiar with these concepts already. If you’re working with a gastrointestinal specialist about your bowel movements already, please continue to do so. 

Should you see any dramatic changes to your bowel movements, it’s also a good idea to keep your primary care provider informed as well as your Revero care team.

Why Pay Attention to Your Stool Quality?

Your gut function is very important for the rest of your health. If you’ve ever had gas, bloating, constipation, or frequent diarrhea you know that it can be extremely uncomfortable. 

Your Revero diet calls for up to four servings per day of vegetables, and the only fruit is one cup of berries per day. What does that mean for bowel movements? 

Eating a little less fiber on a low-carbohydrate diet means that you’ll have less volume of stool to pass during bowel movements. 

Many factors can affect the quality of your bowel movements, including hydration status, stress which can affect intestinal transit time, and the type of food that you eat. Your gut bacteria are an additional variable that plays a role as well. 

The Bristol Stool Chart is a chart that is used to grade the quality of stool:

(Blake, M.R., Raker, J.M. and Whelan, K. (2016), Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 44: 693-703.)

Look at your stool, and see where it fits on the chart. A “3 or 4” is about what we would consider normal. You can use the appearance of your stool, and your Bristol number, to help determine what you can do to make your bowel movements better. It also gives you a way to explain stool consistency to your coach or provider without searching for adjectives. 

Interpreting Your Bristol Scores

Bristol 1-2 indicates some constipation and is a stool that contains less moisture than it should. This type of dry stool is harder to pass, and more likely to be uncomfortable and less frequent. If you’re seeing this type of stool frequently:

• Make sure you’re drinking enough water: eight glasses a day
• Make sure you’re getting enough sodium: 5000 mg a day unless your provider instructs otherwise. Use your two electrolyte packets, plus liberally salting your food, to achieve this goal. 

Bristol 3-4 is considered normal and healthy. Note that having a Bristol 3 or 4 at a reduced frequency, like every other day, does not indicate constipation. These should be comfortable bowel movements without major straining. 

Bristol 5 contains more fluid, and is a little loose, almost like diarrhea. A little more fiber can help, so make sure to eat your non-starchy vegetables, nuts, and seeds. 

Bristol 6 and 7 are examples of diarrhea, and are very loose and liquid stools. These typically will also happen more frequently. Possible causes include gastrointestinal infections, drug side effects, or eating something that your body did not agree with. Because these stools contain significant fluid, make sure that you get your water and salt consumption right, or you may get dehydrated. 

If your bowel movements are 6 and 7 regularly when you start your Revero diet, talk to your coach and ask for advice. You may be having trouble digesting fats, for example, and need to change your diet more gradually. 

Getting Those Bristol Threes and Fours

Achieving regular and normal bowel movements is part of improving your health. Here are some general tips that can help:

• Don’t forget your salt and electrolyte packets, along with your 8 glasses of water every day.
• Sometimes light exercise or movement, even just taking a short walk, after eating can help.
• Your vegetables, nuts, and seeds can help also
• If problems persist, check your medications or discuss it with your pharmacist and health coach
• Having some fermented vegetables, like some kimchi or sauerkraut (the real kind with live active cultures) can help your gut bacteria get the upper hand on improving bowel movements
• Because we evolved to have bowel movements while squatting, yet almost everyone in the Western world sits for bowel movements, products such as the Squatty Potty (yes, that is “a thing”) can really help as well! 

Note: Revero is not an emergency clinic. Should you notice black stools, bloody stools combined with severe abdominal pain, new and severe pain while defecating, nausea, vomiting, lots of mucus in your bowel movement, or suddenly watery stools, please contact 911.

If you see visible parasites or fragments of worms, very skinny long stools, or difficulty attaining a Bristol 3 or 4, make sure to bring this up with your Revero coach and primary provider.