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Who Is Actually Using the Bristol Scale in Their Pursuit of the Perfect Shit?

You may have heard of this legendary excretion-judging chart, but is it something people ever really break out IRL?

You’ve probably heard of the Bristol Stool Scale, but if you haven’t, well, here it is in all its semi-solid glory:

As you can easily see, the Bristol Stool Scale is a scale for your stool: a way to discern the hardness or softness of your shits, and what that consistency may mean for your general health. Starting at the top, you have Type 1, which is a bunch of hard little nuggets, which likely means you’re constipated. On the other end of the shit spectrum is Type 7, pure liquid, which means you’ve got diarrhea. Pretty simple!

Because poo is hilarious, fascinating and occasionally out-of-this-world, this visual poop scale is often regarded as little more than a joke. For example, there’s this fairly terrifying toilet monster image; this version of the chart featuring a shit with sunglasses; and my personal favorite, a Bristol Stool Scale comparing all your shits to candy bars.

But despite its hilariousness, the Bristol Stool Scale is actually a useful, scientific scale, one that’s been utilized in actual medical settings since it was first developed back in 1997. Originally, the scale was developed by a few doctors at the British Royal Infirmary as a way to measure stool consistency for a study measuring transit times (i.e., when food enters the body and when it exits). While transit times vary from person to person, the stool chart developed for the study was found to be useful not only for this research but for future diagnosing, identification and communication around stool consistency. (As an aside, I now find the word “infirmary” hilarious given the content of the Bristol Stool Scale. I know, I know, I’m a child.)

Anyway, since that study, the Bristol Stool Scale has proven to be useful for doctors all over the world as a way to diagnose gastrointestinal issues. That said, the scale by itself can’t tell you what’s wrong with you — if you’re shooting out hard little Type 1’s, sure, you’re constipated, but why you’re constipated still needs to be discerned. 

Even then, simply having either Type 1’s or Type 7’s doesn’t necessarily mean that there’s something wrong: As gastroenterologist Nitin Ahuja explains, a stool consistency that’s too hard or too soft isn’t concerning by itself. “Some people are chronically constipated and they pass Type 1 stools all the time, but they’re not impaired by that. More often I think what’s concerning is sudden change in bowel movements,” says Ahuja. So while the scale says that only Type 3 and Type 4 are “normal,” Ahuja elaborates by saying that “normal” is a pretty broad generalization and that “normal” may vary between different people. Of course, if you’re suffering from chronic diarrhea or constipation, that doesn’t mean don’t see a doctor, it just means that your type of shit alone doesn’t tell you much. 

Instead of specifically telling you what’s wrong, then, the Bristol Stool Scale is used by doctors as a way to bridge communication more than anything else. As Ahuja points out, “A lot of the language around GI symptoms can be homegrown, so people come to understand ‘normal’ in various subjective terms. What one person means by loose stools or hard stools can be different from what the next person means. So, just in terms of standardizing a sense of consistency, the scale is a helpful tool.” 

Because people don’t normally talk about their shits — we do, of course, but not everyone does — it can sometimes be difficult to talk to our doctors about them. So if you’re used to Type 4’s, but you start shitting out Type 3’s, you may call that constipated, when generally, that’s what’s considered “normal.” Or if you’re used to harder poops, a Type 4 might seem like diarrhea, when really it’s just a bit softer than what you’re used to. Basically, the main purpose of the Bristol Stool Scale is a way to standardize what people are talking about — a way to make sure we’re all on the same shitty page. Once that’s been established, then a doctor can start to look at what’s going on. 

While communication is the primary use of the Bristol Stool Scale, Ahuja explains that some of his colleagues use it a bit more intensively than he does, by giving their patients their own copy of the scale in order to know what to strive for. “They might say to a patient to adjust their Miralax to get to a certain goal. So if they have Type 1, take this much, or Type 2, take that much.” So in addition to doctors using the scale to help to communicate with their patients, there are some people with gastrointestinal issues who are told to go home and track their poops, in order to know what to strive for and hopefully make their bowel movements more comfortable. 

In terms of its research applications, just as when it was first developed, some scientists use the scale to help in various studies. For example, there’s this study where it was used to examine stool consistency in toddlers, and another where it was used to help assess how effectively people’s bowels were being emptied by various stool consistencies. Even 22 years after being developed, this versatile tool is still useful for researchers in gastroenterology. “The Bristol School Scale is good for what it is,” Ahuja summarizes. While occasionally others will say they’ve figured out some better method for poop identification, the simplicity of the Bristol Stool Scale has proven to stand the test of time as an effective way for researchers, doctors and even patients to discern what the fuck is going on with their shit. 

As for whether or not it’ll help you attain the perfect shit, well, there’s really no such thing. As Ahuja makes clear, it’s all subjective considering one’s diet, transit time and comfort. So while Type 3’s or Type 4’s may be the most comfortable to pass, they may still not be your normal. Indeed, when it comes to shits, there’s only one truly perfect shit that’s ever been, and, ladies and gentlemen, here it is: