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The Bristol Stool Form Scale

The Bristol Stool Scale or Bristol Stool Chart is a medical aid designed to classify the form of human feces into seven groups.  It was developed by Heaton and Lewis at the University of Bristol and was first published in the Scandinavian Journal of Gastroenterology in 1997.  The form of the stool depends on the time it spends in the colon.

Dr. Campbell-McBride recommends enemas as the first line of defense for fighting constipation and fecal compaction.  Please refer to her book, Gut and Psychology Syndrome for detailed recommendations for administering enemas in both adults and children.

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Type 1 has spent the longest time in the colon and type 7 has spent the least.  Stools at the lumpy end of the scale are hard to pass and often require a lot of straining.  Stools at the loose or liquid end of the spectrum can be too easy to pass - the need to pass them is urgent and accidents can happen.  The ideal stools are types 3 and 4, especially type 4, as they are most likely to glide out without any fuss.

What type of stools are best?

  • The feeling you need to go is definite but not irresistible
  • Once you sit down on the toilet there is no delay
  • No conscious effort or straining is needed
  • The stool glides out smoothly and comfortably
  • Afterwards there is only a pleasant feeling of relief
  • All this is most likely if the stool is Bristol Stool Form Scale, type 4

*When it comes to defining the "ideal" stool, there is some debate.  For another interpretation, please view Fiber Menace.


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Constipation is a very common problem in patients suffering from digestive conditions.  The bacterial environment in the GI tract, especially the lower bowel, can contribute to fecal compaction, as well as a lack of lubrication and poor fat digestion.  In the long run, Dr. Campbell-McBride believes the GAPS Protocol will balance the bacterial ecosystem and remove constipation.


Enemas are Dr. Campbell-McBride's first recommendation for alleviating constipation

If the patient starts on the Introduction Diet, it is recommended to introduce juicing right from the beginning as well as fermented, cooked, and raw vegetables.  Some patients find it better for them to start with the Full GAPS Diet if constipation is severe while continuing to juice with fresh organic fruits, vegetables, and herbs.  GAPS milkshakes are also recommended.

As an occasional remedy Dr. Campbell-McBride has said it is OK to use glycerine suppositories, as well as castor oil packs on the abdomen or magnesium oxide powder.

Replace high-protein dairy with high-fat dairy.  Replace muscle meats with gelatinous meats and increase the amount of cooked vegetables being consumed.

Some patients find it beneficial to supplement with seaweed, magnesium, pancreatic enzymes and/or Betaine HCl.