Bowel health
Bowel symptom diary
Track your bowel movements, symptoms, and daily habits and bring it to your appointment.
Complete each row for the number of days your provider recommends. Use the Bristol stool type scale to describe each bowel movement.
Bristol stool type scale
Type 1Separate hard lumps, like nuts (hard to pass)Severe constipation
Type 2Sausage-shaped but lumpyMild constipation
Type 3Like a sausage but with cracks on its surfaceNormal
Type 4Like a sausage or snake, smooth and softNormal
Type 5Soft blobs with clear-cut edges (passed easily)Lacking fiber
Type 6Fluffy pieces with ragged edges, a mushy stoolMild diarrhea
Type 7Watery, no solid pieces, entirely liquidSevere diarrhea
Simple illustrations of the general shape of each type. Types 3 and 4 are considered normal. Types 1 and 2 point to constipation, type 5 can mean too little fiber, and types 6 and 7 point to diarrhea.
Diary
Name: ______________________ Start date: ______________
| Day | Time | Type of bowel movement (Bristol 1 to 7) | Incontinent / no control | Stain or smear | Pain | Emotional status |
|---|---|---|---|---|---|---|
| 1 | ||||||
| 2 | ||||||
| 3 | ||||||
| 4 | ||||||
| 5 | ||||||
| 6 | ||||||
| 7 | ||||||
| 8 | ||||||
| 9 | ||||||
| 10 | ||||||
| 11 | ||||||
| 12 | ||||||
| 13 | ||||||
| 14 |
Please list: all daily medications, vitamins and supplements, and daily exercise.
| Medications, vitamins, supplements, exercise |
| Comments |
This handout is for education and does not replace advice from your own healthcare provider.