Stool Diary Template

Fill in the diary for a whole week or longer if your doctor or nurse asks for it.

Stool diary template. This helps assess how long the stool has spent in the bowel. 1 1 07 11 00 a m walked 1 mile a little anxious slight stomach cramps constipation mon. Sunday monday tuesday wednesday thursday friday saturday food drink note the time and the food and drink consumed discomfort pain note the time and intensity of the pain 0 no pain 10 worst possible pain bowel movement note the time and consistency of the stool. L large m medium sm small e g large soft stool and 3type or.

Ham sandwich chips 20 oz soda relaxed but tired slight stomach cramps constipation mon. Stool type use the bristol stool form scale on next page record any accidents leakage. Your child s frequency and stool type can vary because of a range of factors but ideally your child s stool should be in the type 3 to type 5 range and should be occurring on a fairly consistent pattern. Nuts type 2 type 3 type 4 sausage shaped but lumpy like a sausage but with cracks on its surface like a sausage or snake smooth and soft type 5 soft blobs with clear cut edges type 6 type 7 passed easily fluffy pieces with raged edges a mushy stool watery no solid pieces.

Mushy stool type 7 watery no solid pieces entirely liquid when you have a bowel movement place the number that best characterizes your stool type in the appropriate place in the table. Entirely liquid choc children s. On the journal below record the type of stool your child had with a simple 1 7 that corresponds to the scale and the time of day. Fbd weekly diary day date time food s eaten activities emotional status stool type symptoms severity example.

Bowel constipation downloads incontinence. When recording b m s note both size. Write in whatever laxatives have been taken that day including the dose. Click here to download our bowel diary.

The stool diary is a chart for recording daily bowel movement details such as time presence of incontinence stool seepage or staining stool consistency and urgency. Ibs diet symptoms diary week. The aim is to improve the consistency of your stools to establish a regular time for you to empty your bowels and to find ways of stimulating your bowels to empty. Normal watery loose hard difficult to.

Additional details such as use of pads medications and other comments can be recorde d. 5pm 6pm 7pm 8pm 9pm 10pm 11pm. H hard s soft d diarrhea s 4 for type numbered 1 to 7 you can also use the bristol stool chart on back of page x checked with client and no b m. At the end of every day check to make sure no poos were forgotten.

Bristol stool form scale. Bristol stool chart type i.