The Bristol Stool Form Scale

When, on the doctor’s instruction, I asked at reception if the District Nurses might contact me regarding incontinence pads for my mum, they said it would be at least two weeks before they would get in touch (I did wonder how this might be helpful when it was now that Mum was suffering from diarrhoea). So imagine my surprise when two days later I was just about to go to my Thrivine Trustees meeting when there was a knock on the door and when I opened it a woman barged right in.

‘I’ve come to see your mother’, she said, curtly. To which I replied, trying to muster a smile, ‘and you must be the district nurse?’ With no further introduction she said, ‘I came yesterday, but you were out.’ Then, turning to my mother accusingly, ‘Were you out?’ Mother looked blankly at her as I said, ‘Yes, we had to attend an appointment at the hospital – Stroke Clinic! I wasn’t expecting you, at the doctors’ reception they said it would be two weeks before I would receive contact from you – and I’m just on my way out for an important meeting. Had you phoned me I could have arranged a mutually convenient time.’

Totally undeterred she produced a piece of A4 paper – a ‘Bowel Habit Diary’ and instructed me that I must keep this diary for two weeks, noting the time of bowel movements, whether or not lots of toilet paper was used, if the underwear was marked and the consistency of the stool using the Bristol Stool Form Scale ‘What is the Bristol Stool Form Scale?’ I asked innocently. She seemed astounded at my ignorance and said she would get me a copy from the car.

I explained that I felt (hoped) mum’s incontinence was entirely due to the gastroenteritis and not a normal event. Again she looked at me accusingly – ‘so you don’t want to complete the form?’ I gathered by the tone of her voice that it wouldn’t be prudent for me to decline, so I meekly took the form from her. (You may be picturing this nurse as a big old battle-axe, but not so – she was youngish and even smaller than me, which would make her less than 5ft).

To try and ease the tension I explained the situation over recent days and the fact that I though Mum also had a urine infection, but I had been told I must wait five days for the result. ‘What?’ She scoffed. ‘We would done a dip-stick test right away!’ ‘That’s what I was expecting,’ I concurred. ‘Ridiculous!’ and with that she left, muttering. I ran bare-footed out to the car to remind her that she was to give me the stool chart. With no time to look at it I made a mad dash to my meeting.

Looking later at the Bristol Stool Form Scale, I fell about laughing. ‘Who would be a graphic designer?’ I thought. There are seven types of stool depicted in the illustrations, ranging from ‘Separate hard lumps’ through to ‘Watery, no solid pieces ENTIRELY LIQUID.’ Speaking as a once graphic designer/illustrator, I have had some uninspiring things to draw, but none so shitty as this. Then I noted that it was reproduced by kind permission of Dr KW Heaton of Bristol University and I became full of admiration for him/her. From these illustrations I was able to easily identify Mum’s stools for the following two weeks. The form given me by the nurse was far less easy to use – not allowing enough space for the many times Mum passed a stool on some days and under the heading ‘Did you mark your pad/underwear,’ I found myself writing ‘No – floor, yes,’ or ‘wall yes’, but that’s another story… .

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