Advanced Naturopathic Case Taking: Naturopathic Evaluation Tools: Stools

Question 1

Bristol Stool Chart:

Answer 1

• The Bristol Stool Chart is a medical aid developed at the University of Bristol that helps to differentiate what a healthy stool looks like and what other types may mean.
• Stools are a good indicator of an individual’s health. There should be easy passage, a feeling of complete evacuation afterwards and type 3–5 on the Bristol Stool Chart.
• A stool chart can be handy to help ease the embarrassment of having your client describe their stool.

Question 2

The ‘ideal’ stool

Answer 2

• The ideal stool neither sinks nor floats but is mostly submerged. It is a medium brown colour with no obvious undigested food remnants (corn, seeds etc., won’t break down) & stool may be coloured from certain foods.
• Type 1 & 2 seen more in constipation.
• Type 3 & 4 are more common in a more protein-rich or Western-style diet.
• Type 5 is a softer bulkier stool associated with a more veggie or vegan diet.
• Type 6 & 7 seen more in diarrhoea.

Question 3

Type 1 and 2

Answer 3

• Seen more in constipation.

Question 4

Type 3 and 4

Answer 4

• More common in a more protein-rich or Western-style diet.

Question 5

Type 5

Answer 5

• A softer bulkier stool associated with a more vegetarian or vegan diet.

Question 6

Type 6 and 7

Answer 6

• Seen more in diarrhoea.

Question 7

Floating:

Answer 7

• Tend to not flush away / float on the surface of the water.
• This indicates that fats in the diet are not emulsified properly by bile.
• This can be due to an excessive intake of fats, or insufficient bile.

Question 8

Sinking:

Answer 8

• Heavy with decaying matter or non-used minerals.

Question 9

Thin stools:

Answer 9

• Tension (colon spasm as seen in irritable bowel syndrome).

Question 10

Dry stools:

Answer 10

• Poor water intake, slow transit time — poor fibre, hypothyroid, stress.

Question 11

Infrequent stools:

Answer 11

• Constipation is defined as passing stools less than 3 x per week, needing to strain or passing hard pellet-like stools on more than a quarter of occasions.
• Naturopaths would expect one to three bowel movements per day. Less than one per day would be indicative of reduced function.
• Infrequency may be the result of:
  o A low-fibre diet.
  o Digestive insufficiency—i.e. mechanical (reduced peristalsis) and chemical (e.g. low bile, HCl, pancreatic enzymes).
  o Inadequate water intake / dehydration.
  o A sedentary lifestyle / stress/ a change in route e.g. travelling.

Question 12

Stool colour:

Answer 12

• The colour of a bowel movement is influenced heavily by the presence of bilirubin (in bile).
• The colour can also be a reflection of certain foods which can colour the stool e.g. beetroot, dark green leafy vegetables, liquorice, blueberries.
• Non-food related colours may also be indicative

Question 13

Very pale / clay colour stools:

Answer 13

• Insufficient production of bile.

Question 14

Green stools:

Answer 14

• Release of toxic matter in bile.

Question 15

White mucous in stools:

Answer 15

• Indicates disturbance of intestinal flora, microbial infection or an immune response to gluten, lactose or inflammation from ulceration

Question 16

Very dark brown stools:

Answer 16

• Slow transit time in colon
• Hypothyroidism

Question 17

Orange coloured stool:

Answer 17

• May indicate insufficient bile production or pancreatic lipase enzyme insufficiency.
• The stool is usually frothy and poorly formed.

Question 18

Black tarry stools:

Answer 18

• Red flag (can be indicative of oesophageal/gastric bleed). Refer patient to a doctor.
• Blacker stools can be due to iron supplementation, although should not be tarry.

Question 19

Blood in stools:

Answer 19

• Red flag —refer patient to medical doctor.
• As a general rule of thumb, the darker the stool the further the blood has travelled through the GIT.
• Darker blood is typically a sign of a more serious pathology.
• Bright red blood around the stool / on toilet paper is often caused by haemorrhoids.