It is a diagnostic tool for the classification of the stool in seven levels ranging from solid shape to aqueous diarrhea. It has also found a large use in the pediatric field in the time and today it is a fundamental aid.
Today we are talking about the Bristol scale and the “red flags” who must alarm us in front of a change in the child’s alvo. In particular, we try to understand what are the situations that must make us alarm and which, instead, no.
There Bristol stroke scale It is a simple use tool, applicable to all ages, including pediatric, which is very useful. It is a tool that allows you to make the classification of the stool objective and univocal. In this way it will be easier to realize any alarm bells For gastroenteric pathologies and for the diagnosis and management of constipation therapy, but also to communicate with the pediatrician clearly and simplely.
What is the Bristol scale?
Have you ever heard of the “Bristol scale “? Imagine that your baby wakes up painful, indicates the belly, goes to the bathroom and the feces are not the same as always: The poop seems altered by consistency, shape and color. Do you have to worry? You have no idea, so take the phone and call your trusted pediatrician to get a comparison. How to communicate exactly how this poop is made? It is not liquid, it is not solid, it does not have the form ever and moreover has changed characteristics during the latest evacuations (they are all different from each other).
Just in these situations we help us the Bristol scalea visual proposal that is based on the help of stylized images of the stool associated with a grading growing numerical. The Bristol scale is a tool that makes objectively and univocal the classification of the consistency of the faecal mass. In essence, you can clearly define the characteristics of the stool when you request a consultation indicating the number corresponding to the image that most approaches the evacuation of the child or girl e implement shared monitoring in an objective way in the days when the malaise persists.
La Scala di Bristol, owes the name to the University of Medicine of Bristol in which he takes his first steps thanks to the work of two English doctors, Ken Heaton and Stephen Lewis. There Bristol scale definition or “Bristol Stool Chart”It is proposed for the first time in 1997: it is one diagnostic tool for classification of feces in Seven levels ranging from solid shape to aqueous diarrhea. Initially employed in the clinical and experimental field for the management of the adult alvo disorders, it has found wide use in the pediatric field in the time and today it is a fundamental aid In the management of patients with acute and chronic pathologies of the gastrointestinal system and for the diagnosis and management of the therapy of the very frequent “functional constipation” that often affects our children.
What is the Bristol scale for?
Because it is used the Bristol scale? This It is used to make the management and diagnosis of the patient more precise with an alvo disorder both for the daily evaluation of the child with chronic/recurrent intestinal pathology (in a diary of evacuations), and for taking charge of children who demonstrate acute and transient symptoms.
There Bristol scale distinct Seven types of stool based on the form and consistency. Specifically identifies how type 1 the goats, consisting of lumps of increased consistency that often The child has difficulty evacuating Because feeling pain in expulsion. Al type 2 Fecki composed of spheres joined together with each other belong to form cords. The feces that belong to the type 3in the shape of salami but of increased consistency (as can be seen from the presence of cracks on their surface).
Exactly half and corresponding to the standard is type 4: I am simple to evacuatehave one consistency softdo not have cracks on the surface and have a salami or snake shape. THE Types from 5 to 7 are characterized by progressive reduction of consistency and form. If in the type 5 The soft and smooth “snake” begins to fragment in several well -identifiable pieces with each other (we could “count them”), we will describe how type 6 The picture in which the pieces become numerous, jagged and shaved. Finally, in type 7 No fragment is recognizable: the feces are watery and do not have any solid component.
In summary, the key characteristics of the Bristol scale are as follows:
- type 1hard and separated lumps difficult to evacuate;
- type 2lumps united together to form a sausage;
- type 3salami -shaped with cracks on the surface;
- type 4sausage or snake -shaped, smooth and easy to expel;
- type 5soft and separated fragments, with well -defined margins;
- type 6shapeless, jagged pieces;
- type 7watery.
Bristol scale and children’s poop: when to worry
Now we know how to objectively describe the feces and attribute a code that immediately makes our careful understand what we are talking about.
But When worry? What are the elements that fear us compared to a change in children’s poop? We have to check 3 alarm bells: color, shape and frequency.
Child’s poop color
One of the important aspects that we immediately notice when we observe the feces is the color. The color of the poop of children Change according to their diet and many factors, both physiological and pathological, but the real alarm bells regarding the coloring of the stool are 3:
- redlive red is the color of non -digested bloodtherefore generally indicative of distal bleeding (the last stretch) of the gastrointestinal system (more often from the rectum). More frequently caused by slight disorders like a damage to the rectal transitional mucosa (for example secondary to an entry infected by schoolmates) or to be charged to the presence of a fissies anal (especially in constipable children). The blood in the children’s stool remains an event that requires clinical evaluation by the careful;
- blackis the color of the digested bloodindicates bleeding that derives from a portion of the proximal gastrointestinal tract (more distant from the rectum). It always deserves a clinical evaluation and diagnostic tests;
- whitein technical jargon we speak of “acolic” feces, these are the stool in which the component that causes its typical coloring is missing (the stecobilinogen, a waste product of bilirubin produced by the biliary tract). It is generally associated to pathologies against the biliary tract (altered production of bile or difficulty in excretion). Generally, the feedback of white feces is associated with other very evident clinical notes, difficult for it to escape. For example, these children or girls can present jaundice (colored yellow), have ray itching or make dark pee (“coca-cola” color). The most common causes of hypocholic or acolical feces is the atresia of the bile tracts (but also the presence of cysts in the Coledoco, Tubicino that allows the passage of the bile in the intestine, which causes the obstruction of the same, or even biliary stones for the same mechanism). Like the two previous cases, it must always be subjected urgently to the attention of the doctor.
Form of the child’s feces
If we resume the issue of the form from the poop of children, looking at our now familiar Bristol scale, We will worry in the case of extremes: types 1, 2, 6 and 7.
THE first two types indicate a more or less serious degree of constipationoften in the child connected to the retention attitude (refer the evacuation) or to poor hydration, or a poor fiber diet. For the child it is important to be timely in diagnosis And in therapy as the evacuation of hard feces constitutes a painful and “avoidable” event (they will try to postpone as much as possible if they have suffered in making poop) and this conduct by the child triggers a vicious circle that further increases the consistency of the stool and the pain in an attempt to defecate.
In most cases the cause is not to be charged to an organic pathology and we speak of “functional constipation”, your pediatrician will help you to Improve water and fiber contributions And it will support at least the first phase of management with drugs that help to soften the feces to reduce the pain connected to the evacuation and restore the correct habit and routine to the elimination of the stool.
Unfortunately, there are cases in which constipation can be associated with a basic pathology. Among the red flags of which your careful will take into account the well -known anamnestic (the story after birth) of a delayed emission of the meconio (it was late and perhaps with difficulty the “first poop”), the presence of anatomical anomalies of the urogenital district (in particular as regards the children who show constipation already in the first months of life) and the emission of nastriform feces ( They have the shape of the snake or sausage but which look like crushed ribbons).
The type 3 approaches an ideal conditiontype 4 indicates the stools considered normal, easy to expel and follow from a sense of complete emptying of the intestine.
If type 5 can be part of a normal routine, the sixth is already indicative of an alvo tending to diarrhea and the seventh is frankly diarrheal. Also in this case it is more frequently Transient disordersoften caused by the contagion of infectious agents, almost always virus, which cause an entry. The only therapy in these cases is the hydration of the childto reintegrate losses; Rehydration can be made by mouth with rehydrating or intravenous solutions if the attempt to rehydrate by mouth fails. The incorporation, if the child shows appetite, must be quick. quick.
Number of evacuations
Another parameter, in addition to color and consistency, of which we must take into account is the number of evacuations.
We will talk about diarrhea If the number is greater than the usual one and the consistency according to the Bristol stroke scale it is watery (type 6-7). A child can instead be defined as constipated when he gets rid of effort and pain, he warns that he has emptied incompletely or the stool are hard, dry, or goats (type 1 or 2 according to the Bristol scale).
Defecation is a physiological act that can undergo variations that In most cases they are transient and benignleave no trace or ailments over time, and that often even when they persist totally reversible if an adequate lifestyle and correct therapy are implemented.
