PATIENT PRESENTATION MARKER

Hard lumpy stools

What this marker measures

The extent to which the patient reported passing hard or lumpy stools (type 1-2 on the Bristol stool scale).

Health categories/Interpretations informed by this marker

Gut function
● Slower colonic transit: hard, lumpy stools (type 1-2 on the Bristol stool scale) may be an indication of slower colonic transit.^1–4
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Clinical features
‍● Lower GI symptoms: hard lumpy stools is a commonly-reported lower gastrointestinal symptom that can affect quality of life.
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Interpreting the result

PRESENT

Questionnaire responses indicate hard or lumpy stools more than 25% of the time.

PARTIALLY PRESENT

Questionnaire responses indicate hard or lumpy stools 25% of the time or less.

NOT PRESENT

Questionnaire responses indicate hard or lumpy stools rarely or never.

Patient management insights

DIETARY STRATEGIES

Add ground flaxseed: ground flaxseed may help soften hard/lumpy stools in functional constipation.^5–7
GRADE C

Add psyllium husk: psyllium husk may increase stool frequency, soften stool form, reduce straining severity, and increase complete spontaneous bowel movements in functional constipation.^8,9
GRADE D

SUPPLEMENTATION

Take PHGG: partially hydrolysed guar gum may improve bloating, stool frequency, stool form, straining, incomplete emptying sensation, abdominal pain and reliance on laxatives in patients with constipation, including those with slow transit.^10–12
GRADE D

Tips for patients discussion

"Your questionnaire responses show that you often pass hard or lumpy stools. This is common and can affect how you feel day to day. There are some simple options we can try, such as adding fibre like ground flaxseed or psyllium husk, and we'll start with the one that best suits your situation."

Source references for all clinical associations, interpretation definitions, and patient management insights on this card.

1. Lewis, S. J. & Heaton, K. W. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 32, 920–924 (1997).
2. Saad, R. J. et al. Do stool form and frequency correlate with whole-gut and colonic transit? Results from a multicenter study in constipated individuals and healthy controls. Am J Gastroenterol 105, 403–411 (2010).
3. Jaruvongvanich, V., Patcharatrakul, T. & Gonlachanvit, S. Prediction of delayed colonic transit using Bristol stool form and stool frequency in Eastern constipated patients: a difference from the West. J Neurogastroenterol Motil 23, 561–568 (2017).
4. Agrawal, A. et al. Bloating and distension in irritable bowel syndrome: the role of gastrointestinal transit. Am J Gastroenterol 104, 1998–2004 (2009).
5. Soltanian, N. & Janghorbani, M. A randomized trial of the effects of flaxseed to manage constipation, weight, glycemia, and lipids in constipated patients with type 2 diabetes. Nutr Metab (Lond) 15, 36 (2018).
6. Sun, J. et al. Effects of flaxseed supplementation on functional constipation and quality of life in a Chinese population: a randomized trial. Asia Pac J Clin Nutr 29, 61–67 (2020).
7. Ma, J. et al. Influence of flax seeds on the gut microbiota of elderly patients with constipation. J Multidiscip Healthc 15, 2407–2418 (2022).
8. van der Schoot, A. et al. The effect of fiber supplementation on chronic constipation in adults: an updated systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 116, 953–969 (2022).
9. Erdogan, A. et al. Randomised clinical trial: mixed soluble/insoluble fibre vs. psyllium for chronic constipation. Aliment Pharmacol Ther 44, 35–44 (2016).
10. Kapoor, M. P. et al. Impact of partially hydrolyzed guar gum (PHGG) on constipation prevention: a systematic review and meta-analysis. J Funct Foods 33, 52–66 (2017).
11. Polymeros, D. et al. Partially hydrolyzed guar gum accelerates colonic transit time and improves symptoms in adults with chronic constipation. Dig Dis Sci 59, 2207–2214 (2014).
12. Russo, L. et al. Partially hydrolyzed guar gum in the treatment of irritable bowel syndrome with constipation: effects of gender, age, and body mass index. Saudi J Gastroenterol 21, 104–110 (2015).