Bristol stool scale - Wikipedia Bristol stool scale This is the latest accepted revision, reviewed on 30 August 2017. This article contains translated text and needs attention from someone fluent in Italian and English. Please see this article 's entry on Pages needing translation into English for discussion. If you have just labeled this article as needing attention, please add ( ( subst : Duflu pg = Bristol stool scale Language = Italian Comments = ) ) ~ ~ ~ ~ to the bottom of the WP : PNTCU section on Wikipedia : Pages needing translation into English. Bristol stool chart The Bristol stool scale, Bristol stool chart ( BSC ), Bristol stool form scale, or BSF scale is a diagnostic medical tool designed to classify the form of human faeces into seven categories. It is used in both clinical and experimental fields. It is sometimes referred to in the UK as the Meyers scale. 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 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. 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 ; 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. 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 ). Contents 1 Interpretation of the scale 2 Versions 3 Uses 3.1 Diagnosis of IBS 3.2 Therapeutic evaluation 4 References 5 Bibliography 6 See also Interpretation of the scale The seven types of stool are : 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. 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. Versions The same scale is also validated in a Spanish version, and a version has also been designed and validated for paediatrics. 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. Uses Diagnosis of IBS See also : irritable bowel syndrome and Rome process 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. Research conducted on irritable bowel syndrome in the 2000s, faecal incontinence and the gastrointestinal complications of HIV have used the Bristol scale as a diagnostic tool easy to use ; even in research which they lasted for 77 months. 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 ). More recently, according to the latest revision of the Rome III Criteria, six clinical manifestations of IBS can be identified : Subtypes prevalent presentation of stool in IBS according to the Rome III Criteria 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. 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 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. Distribution of risk factors in three groups classified according to the colonic transit and subgroups classified according to the type of feces model century 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 ) 5 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 evaluation 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. In a randomised controlled study, 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. 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, moxicombustion, laxatives in the elderly, preparing Ayurvedic poly - phytotherapy filed TLPL / AY, psyllium, mesalazine, methylnaltrexone, and oxycodone / naloxone. Or to assess the response to physical activity in athletes. References Jump up ^ 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. Jump up ^ Gut Sense What Exactly Are Normal Stools ?, Konstantin Monastyrsky. Accessed July 2015 Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ General Practice Notebook. `` Meyers Scale - General Practice Notebook ''. Retrieved 2015 - 05 - 09. Jump up ^ `` Bristol Stool Scale Stool Forms Colon Cleanse Organ Cleansings Cleanse & Detoxify Health Science @ Wellness Advantage......... ``. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ Bristol scale stool form. A still valid help in medical practice and clinical research G Riegler, I Esposito -- Techniques in coloproctology, 2001 -- Springer Jump up ^ 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. ^ Jump up to : 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. Jump up ^ 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. Jump up ^ 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. ^ Jump up to : 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. ^ Jump up to : 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ `` Medscape Log In ''. Jump up ^ `` IBS, Irritable Bowel Syndrome ''. ^ Jump up to : 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. Jump up ^ 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. ^ Jump up to : 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Bibliography 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. E. South - Paul, Jeannette ; C. Matheny, Samuel ; L. Lewis, Evelyn ( 4 September 2007 ). McGraw - Hill, ed. Current diagnosis & treatment in family medicine. ISBN 978 - 0 - 07 - 146153 - 5. Marie Borgelt, Laura ; Beth O'connell, Mary ; Ann Smith, Judith ; Anton Calis, Karim ( 2010 ). ASHP, ed. Women 's Health Across the Lifespan : A Pharmacotherapeutic Approach. pp. 513 --. ISBN 978 - 1 - 58528 - 194 - 7. J. Greenberger, Norton ; Blumberg, Richard ; Burakoff, Robert ( 23 April 2009 ). McGraw Hill Professional, ed. Current Diagnosis and Treatment in Gastroenterology, Hepatology, and Endoscopy. pp. 282 --. ISBN 978 - 0 - 07 - 149007 - 8. Bs Jd Cnc Roy Mankovitz ( January 2009 ). Montecito Wellness LLC, ed. Nature 's Detox Plan - A Program for Physical and Emotional Detoxification. pp. 29 --. ISBN 978 - 0 - 9801584 - 8 - 9. Jeanette M. Potts ( 19 March 2008 ). Springer, ed. Genitourinary pain and inflammation : diagnosis and management. pp. 121 --. ISBN 978 - 1 - 58829 - 816 - 4. Zderic, Stephen ; Platcher, Natalie ; Kirk, Jennifer ( 15 September 2008 ). SLACK Incorporated, ed. Pediatric Urology for the Primary Care Provider. pp. 22 --. ISBN 978 - 1 - 55642 - 785 - 5. See also Colon Constipation Diarrhoea Fecal impaction Human faeces Intestine Find more aboutBristol stool scaleat Wikipedia 's sister projects Media from Commons Data from Wikidata medicine portal Retrieved from `` https://en.wikipedia.org/w/index.php?title=Bristol_stool_scale&oldid=797976548 '' Categories : Feces Gastroenterology Medical assessment and evaluation instruments Medical scales Physiology Stool tests University of Bristol Hidden categories : CS1 French - language sources ( fr ) Wikipedia pending changes protected pages ( level 1 ) Wikipedia articles needing cleanup after translation Wikipedia articles needing cleanup after translation from Italian Use British English from January 2014 Use dmy dates from January 2014 Wikipedia articles needing clarification from February 2017 Talk Contents About Wikipedia Brezhoneg Català Cymraeg Dansk Deutsch Español Français Galego Bahasa Indonesia Íslenska Italiano Nederlands Norsk Polski Português Русский Suomi Svenska 中文 Edit links This page was last edited on 30 August 2017, at 07 : 53. 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Question: where did the bristol stool chart come from
Answer: England