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Sample: Stool Chart/Bowel Record

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Stool Chart/Bowel Record

Type 6 and 7 may indicate unformed stools/diarrhea.

Date Time Type Estimated Amount Initials


(yyyy-Mon-dd) (hh:mm) (see Bristol Stool Chart) (see guidelines below, choose one) S/M/L

p l e
a m
S
Type 1 Separate hard lumps, like nuts (hard to pass) Amount Estimates

< Small (S): less than 1/2 cup (125 mL)
Type 2 Sausage-shaped but lumpy

< Medium (M): 1/2 -1 cup (125-250 mL)
Bristol Stool Chart

Type 3  Like a sausage but with cracks on the surface


< Large (L): greater than 1 cup (250 mL)

Type 4  Like a sausage or snake, smooth and soft

Type 5 Soft blobs with clear-cut edges




Type 6  Fluffy pieces with ragged edges, a mushy stool

Type 7 Watery, no solid pieces. Entirely liquid




20404(Rev2016-10) Side A
Stool Chart/Bowel Record

Type 6 and 7 may indicate unformed stools/diarrhea.

Date Time Type Estimated Amount Initials


(yyyy-Mon-dd) (hh:mm) (see Bristol Stool Chart) (see guidelines below, choose one) S/M/L

p l e
a m
S
Type 1 Separate hard lumps, like nuts (hard to pass) Amount Estimates

< Small (S): less than 1/2 cup (125 mL)
Type 2 Sausage-shaped but lumpy

< Medium (M): 1/2 -1 cup (125-250 mL)
Bristol Stool Chart

Type 3  Like a sausage but with cracks on the surface


< Large (L): greater than 1 cup (250 mL)

Type 4  Like a sausage or snake, smooth and soft

Type 5 Soft blobs with clear-cut edges




Type 6  Fluffy pieces with ragged edges, a mushy stool

Type 7 Watery, no solid pieces. Entirely liquid




20404(Rev2016-10) Side B

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