Bristol Stool Chart: The 7 Types and Using It in Care

The Bristol stool chart is a seven-point scale that sorts poo by its shape and texture, from type 1 (separate hard lumps) to type 7 (entirely liquid). Types 1 and 2 suggest constipation, types 3 and 4 are generally seen as ideal, and types 6 and 7 suggest diarrhoea. It gives everyone the same words for something people find awkward to describe.

Where the chart comes from

The chart, also called the Bristol stool scale or Bristol Stool Form Scale, was developed by Dr Stephen Lewis and Dr Ken Heaton at the Bristol Royal Infirmary. Their study, published in the Scandinavian Journal of Gastroenterology in 1997, followed 66 volunteers and found that the form of a stool tracked how long it had taken to pass through the gut.

That's what makes it useful. "A bit loose" means different things to different people. "Type 6" means the same to the carer on nights, the nurse on days and the GP reading the record.

The 7 Bristol stool chart types

1. Type 1: separate hard lumps, like nuts, that are hard to pass. Suggests constipation.
2. Type 2: sausage-shaped but lumpy. Suggests constipation.
3. Type 3: sausage-shaped with cracks on the surface. Normal.
4. Type 4: sausage or snake-shaped, smooth and soft. Normal, and often described as the ideal.
5. Type 5: soft blobs with clear-cut edges, passed easily. Some NHS charts count this as normal too.
6. Type 6: fluffy pieces with ragged edges, a mushy stool. Suggests diarrhoea.
7. Type 7: watery, with no solid pieces, entirely liquid. Suggests diarrhoea, but see the warning on overflow below.

The Bladder & Bowel Community describes a healthy stool as type 3 or 4, passed every one to three days depending on the person. The NHS says constipation is likely if someone hasn't had a poo at least three times in the last week, or is going less often than usual for them. What matters most is a change.

Type 6 stool: when loose stools matter

A type 6 is a mushy stool at the loose end of the scale. One on its own doesn't tell you much. Look at the pattern: several in a row, a change from what is normal for the person, or other signs such as tummy pain, blood, being sick or dehydration. After a spell of constipation, loose stools need a second look (see the overflow trap below).

Using the Bristol stool chart in care records

In care services, the chart usually sits inside a bowel chart, a running record of each movement. CQC's guidance on managing constipation in adult social care (which applies in England) says providers must have a system to identify people at risk, and that care plans should set out:

• what is normal for the person, and changes in behaviour that might signal pain or discomfort
• who is responsible for monitoring bowel habits, taking the person's capacity into account
• what to do if the person hasn't opened their bowels within a set period
• guidance on "when required" laxatives, especially where more than one is prescribed
• who to escalate to, and when to contact the GP, community nurses or emergency services

CQC lists those most at risk, including people over 65, people less able to communicate (for example with dementia, a learning disability or autism), people on medicines that can cause constipation such as iron, antipsychotics and some painkillers, and people with low mobility or low fluid or fibre intake. It suggests a third to a half of people with a learning disability have chronic constipation. Government guidance adds that a sudden change in behaviour should prompt staff to consider a physical cause such as constipation.

A useful bowel chart entry is short and factual: the date and time, the Bristol type, a rough amount, whether the person was continent, and anything unusual such as pain, straining or blood. Record "no bowel movement" each day too. A blank chart could mean nothing happened or nobody wrote it down, and the person whose bowels haven't opened for four days is exactly who you need to spot. Our record keeping training helps staff write clear, objective notes.

When to escalate

Follow the care plan and local policy on who to call first. As a guide, NHS advice says:

• Constipation: see a GP if it isn't improving with treatment, keeps coming back, comes with tummy pain or weight loss without trying, or if bowel habits suddenly change.
• Diarrhoea: get urgent advice from NHS 111 for bloody diarrhoea, signs of dehydration that don't improve with oral rehydration sachets, diarrhoea lasting more than 7 days, or if the person can't keep fluids down. See the NHS page on diarrhoea and vomiting.
• Blood: black or dark red poo, or bloody diarrhoea, needs an urgent GP appointment or a call to 111. Call 999 or go to A&E for non-stop bleeding from the bottom, a lot of blood or large clots.

The overflow trap. CQC warns that in severe faecal impaction, watery stools can give a false impression that constipation has cleared. A type 7 after several days of type 1, or no movement at all, is a reason to escalate, not to tick the chart and move on.

Sudden diarrhoea, especially with vomiting, may also be infectious, so follow your infection control policy. NHS advice is that staff with sickness or diarrhoea stay off work until they have had none for at least 2 days.

Dignity and privacy

In England, Regulation 10 requires providers to treat people with dignity and respect, including ensuring their privacy. In practice that means:

• asking about bowels quietly and privately, using the person's own words for it
• keeping bowel charts confidential, and not discussing them across the lounge or at the dining table
• involving the person where they can, for example by using a picture chart to point to their own type
• asking for consent before any intimate care

Privacy works both ways. CQC notes that carers can sometimes be so cautious about respecting privacy that they inadvertently neglect someone's bowel support needs. NHS England has published a Bristol stool chart and constipation resources for carers to help with this conversation. See also our dignity in care training.

Outside England, check your own regulator's standards: the Care Inspectorate (Scotland), Care Inspectorate Wales or RQIA (Northern Ireland).

How Kasorb can help

Our Bowel Management & Suppositories training is for nurses and trained care staff. It covers normal bowel function, constipation, diarrhoea and faecal impaction, keeping bowel records using the Bristol Stool Chart, diet, fluids and mobility, giving suppositories and enemas where your policy allows, consent, privacy and dignity, and when to escalate. Staff practise under the trainer's observation, with feedback, and your trainer has used these skills for real.

We run it at your premises for up to 10 staff, quoted for your team. Each person gets a Kasorb certificate of completion, emailed the next day, ready for your own supervised sign-off against your policies. It isn't a regulated qualification. For wider bladder and bowel support, see our continence care training.

This guide is for awareness and doesn't replace clinical advice, local policy or the care plan.

FAQs

What is a normal Bristol stool type?

Types 3 and 4 are generally seen as normal: sausage-shaped, either with cracks on the surface or smooth and soft. Some NHS charts also count type 5 as normal. What is usual for the person matters more than any single result, so record each movement and look for changes.

What does a type 6 stool mean?

Type 6 is fluffy pieces with ragged edges, a mushy stool, and it suggests diarrhoea. A single type 6 doesn't tell you much. Look at the pattern, and seek advice if loose stools continue, come with pain, blood or dehydration, or follow a spell of constipation, which can mean overflow.

Can you have diarrhoea when you are constipated?

Yes. With severe faecal impaction, watery stool can leak around the blockage, known as overflow. CQC warns this can give a false impression that constipation has cleared. A type 7 after several days of hard stools or no movement at all should be escalated in line with the person's care plan.

How often should someone open their bowels?

It varies from person to person. The NHS says constipation is likely if someone hasn't had a poo at least three times in the last week, or is going less often than usual. In care, the care plan should record what is normal for that person and when to act.

Why do care homes keep bowel charts?

Because constipation and diarrhoea are easy to miss, especially in people who can't easily tell you how they feel. CQC guidance for England expects providers to identify people at risk, monitor bowel habits and know when to escalate. A daily chart using the Bristol types makes changes visible across shifts.