Intended for healthcare professionals

Rapid response to:

Practice NICE guidelines

Management of faecal incontinence in adults: summary of NICE guidance

BMJ 2007; 334 doi: (Published 28 June 2007) Cite this as: BMJ 2007;334:1370

Rapid Response:

What is an ideal stool?

Norton et al's recommendation to "Try to improve the patient's bowel
habit, aiming for ideal stool consistency and satisfactory bowel emptying
at a predictable time" is praiseworthy but too vague to be helpful for
most people.
Consistency presumably means hardness/softness but this is a research
procedure, never assessed in clinical practice. However hardness/softness
is correlated with stool form or appearance and this is easily assessed
using a validated scale, such as the Bristol Stool Form Scale. On this
Scale, the ideal stool is type 3 or 4 (like a sausage or snake but with a
cracked surface, or like a sausage or snake, smooth and soft). These are
the ideal types because, as shown by the Bristol group (Gut 1991, 32:73-
9), they are the ones least often associated with symptoms like straining,
urgency and feelings of incomplete evacuation. The last symptom can be
called rectal dissatisfaction and I take it that it is the absence of this
which Norton et al mean when they refer to "satisfactory bowel emptying"
(another vague term).

Competing interests:
None declared

Competing interests: No competing interests

05 July 2007
Kenneth W Heaton
retired Reader in Medicine, University of Bristol
formerly Dept of Medicine, Bristol Royal Infirmary, BS2 8HW