Taking Initial Bowel Data

This video explains how to take data to bring to your child’s medical provider. This information will help you make a plan for your child.

In Elimination Basics, we explained how constipation is the leading cause of incontinence in children. Please check out that video first.

Associated Resources:

• The Vermont Continence Project’s BM Data Sheet (pdf) is a form to keep track of your child’s bowel patterns.
• The VCP has a picture-based version of the form. A how to video and a link to the form are at How To Use the BM Record Chart (Video)

A full transcript of the video appears below.

Hi, my name is Chayah Lichtig. I’m the director of the Vermont Continence Project and I’m a licensed occupational therapist. In this video, we are going to talk about taking bowel data to support continence.

So parents often wonder, what’s the purpose of taking this data? We’ll start with the fact bowel issues are the number one underlying cause of incontinence in kids. This is true for kids with disabilities and kids without. It’s true for kids who were continence and loss skills and for kids who have never been continent. It’s even true for kids who only have urine incontinence and no identified bowel issues. So we want to have concrete information about our child child’s bowel habits to support our conversations with our child’s physician school team and your child themselves.

So let’s start with something called the Bristol Stool chart. On the next slide, I’m going to share a picture of a one through seven scale that describes the consistency of stool. Doctors like it because it’s well agreed on. It’s easy to understand and it has some pretty clear visual representations. This is a picture of the Bristol Stool chart.

You will see that the numbers get higher as you go along. A lower number means a drier, harder stool consistency, and a higher number means a wetter, looser stool consistency. Let’s go through the seven numbers in order.

Type one is separate hard lumps. They may be difficult to pass or they may fall out.

Type two is sausage shaped, but dry and lumpy.

Type three is like a sausage, but with cracks on the surface.

Type four is super smooth and soft, like a snake or sausage.

Type five is soft blobs with clear edges. They pass easily.

Type six is fluffy, ragged pieces with soft edges almost liquidy.

And type seven is watery. No solid pieces entirely liquidy.

As you may have already learned from watching videos from our nurse consultant Kelly, you will know that numbers one and two are very strong signs of constipation. Numbers six and seven can also be common signs of constipation. Or they can be signs of other GI problems as well. The Bristol stool scale is a very important piece of data which your child’s doctor will probably ask about, but it’s also helpful to keep track of these other factors.

Frequency. One of the official criteria for constipation is how often your child has a complete bowel movement. Loss of small amounts of stool is not the same as a complete bowel movement. But you’ll also want to know and take track of how often they have small streaks, smears or pebbles size. Note If your child has very small or very large BMs regularly or on occasion, these can be signs that the muscles aren’t working well to push out through shape.

Are your child’s stools shaped like logs or balls? A ball shaped stool means that your child’s colon is very stretched out, allowing stool to collect in a lump rather than squeezed into a tight tube.

Mixed consistency. Does your child have BMs that are dry and hard like a two or three one day and a number six the next day? Or can you see a mix of consistencies in a single BM? These are also signs that GI function is not as smooth and consistent as it could be, and that things are not moving along as we might hope and expect.

Finally, if you are giving any medication at this time for your child’s GI system, please make a note of when and how much you give.

Parents often ask how long to take data That depends on how often your child is struggling and how much you know about their system. If your child has a BM every single day, not just a smear, 5 to 7 days of data is probably enough. If your child has very irregular stool patterns or goes infrequently, try to take data on at least seven complete bowel movements.

Many parents find, however, that once they start paying closer attention to their child’s stool habits, that they notice some of the concerns we’ve mentioned and they seek the support of their child’s PCP sooner. Overall, the goal is to get a clear picture of how your child’s system is working right now so you can make the right choices to help them.

How to take Data: In the resources connected to this video, we have a data sheet that you can use. It has a key that reminds you of all the points that I’ve mentioned in the previous slide. You are encouraged to print that out and use it. You can also use any notebook and pencil or the notes app on your phone or tablet. We find people are most likely to take data when they make it as easy as possible. So we suggest keeping that notebook or data sheet and a pen in whatever location your changing undergarments or disposing of stool.

Some parents don’t know what’s going on with their children’s bowel habits because some children change or use the toilet independently or they don’t want to talk about their stool habits. That’s okay. Some children can take their own data using our existing sheets. We’ve also included a simplified version of our data sheet where kids can circle the poo that looks the most like theirs. We find that children who are having accidents are really motivated to do something that is scientifically proven to help. With the right support, they’re often willing to try things that might feel sort of awkward or embarrassing. Explain to your child that most pee and poop accidents come from problems with poop and that this is the first step of treatment.

Thank you so much for taking the time to watch this video. The information contained in this video is for informational purposes only. It is not a substitute for professional health or medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care professional.