Bristol Stool Type 7: What Watery Stool Means

Bristol type 7 is the loosest stool on the scale: watery, with no solid pieces, entirely liquid. It means the stool reached the toilet carrying far more water than your bowel normally leaves in it. That is all the number itself tells you. It is a description, not a diagnosis, and one type 7 on a bad morning is close to meaningless.

What turns type 7 into information is three things you can count: how many a day, how many days, and what came with it. Three or more liquid stools in 24 hours is diarrhoea by the definition clinicians use. A few days of it is usually a passing infection or something you ate. Liquid stool that has run for weeks, wakes you at night, arrives with blood or fever, or follows a course of antibiotics is a different conversation, and this article is mostly about telling those apart.

Our sibling post on what Bristol type 6 means already covers how the scale was built, what it says about water content and transit, the 5-versus-6 judgement problem, and the standard chronic-diarrhoea blood and stool tests. This one does not repeat those. It spends its words on what is specific to liquid stool: the clock, dehydration, stool testing, antibiotics, the causes that classically produce watery rather than mushy stool, and how to record it so the count is not lost. Where we say we "could not find" something, that reflects our searching of PubMed and Europe PMC for this piece, not proof that nothing exists.

What type 7 is, and the one line that separates it from type 6

Type 7 is the only type on the Bristol scale defined by the absence of solid material. The descriptor on the chart is "watery, no solid pieces, entirely liquid". Everything from type 1 to type 6 is some kind of solid, from hard lumps to fluffy mush. Type 7 is fluid.

The chart grew out of work showing that stool form tracks how fast material moves through the gut. In the study that introduced the scale's responsiveness, 66 volunteers had their whole-gut transit time measured with radio-opaque markers, then took senna to speed things up and loperamide to slow things down. At baseline, stool form correlated with transit time better than stool frequency or stool weight did (r = -0.54), and changes in form tracked changes in transit best of all (r = -0.65) (Lewis 1997). Faster transit, looser stool.

Two things about that finding are worth knowing before you read any chart.

First, the correlations are real but moderate. An r of -0.54 means stool form is a useful guide to transit, not a stopwatch. Many popular charts print a transit time next to each type, such as "type 7: as little as 10 hours". The abstract of the validation paper reports correlations, not per-type hour ranges, and we could not find where those per-type figures come from. Treat them as illustration.

Second, type 7 is the easy one to recognise. When 86 volunteers classified 26 stool models, 81% of classifications were correct overall, and the types that fell below 80% accuracy were 2, 3, 5 and 6, the ones sitting at clinical decision points (Blake 2016). Type 7 was not among them. Liquid is hard to mistake.

The border that does cause trouble is 6 versus 7, and it is the most common version of the question in patient communities. A long r/ibs thread asking what people actually mean when they say "diarrhoea" split roughly into two camps: those for whom it means liquid "with maybe a few lumps in it", and those for whom it means mushy stool that never forms (r/ibs thread). Another person described weeks of liquid that "sounds like peeing" with a few light flakes that dissolved on contact with the water (r/ibs thread).

Is "liquid with a few flakes" a 6 or a 7? Strictly, the chart says type 7 has no solid pieces, so flakes put you at the border. In practice it matters far less than being consistent. Choose a rule, for example "if I could not scoop anything out of it, it is a 7", and apply it every time. A record where the rule drifts from week to week cannot show you a trend.

Is type 7 always diarrhoea?

No. Diarrhoea is a count, not a single stool. The definition used in the 2017 Infectious Diseases Society of America (IDSA) guideline is the World Health Organization's: three or more loose or liquid stools per 24 hours, or more frequently than is normal for an individual person. The same passage adds that frequently passing formed stools is not diarrhoea (Shane 2017).

So one type 7 after a heavy, spicy or fatty meal, followed by normal stools, does not meet the definition. Four type 7s before lunch does. And someone who goes five times a day with well-formed stools does not have diarrhoea, however inconvenient that is.

That definition is for acute, usually infectious, diarrhoea. The British Society of Gastroenterology uses a different frame for the chronic kind, which our type 6 post walks through: loose consistency with increased frequency for more than four weeks (Arasaradnam 2018). Either way, frequency is half of the definition. This is why the recording advice at the end of this article is mostly about counting.

How many days of type 7 is worth a call? The four clocks

Guidelines do not give a single "call on day X" number, because what matters depends on what comes with the liquid stool. What they do give is a set of duration bands, and the tests and treatments change as you cross them. The IDSA guideline describes four (Shane 2017):

Autocomplete tells you people search this by the day: "type 7 stool for 3 days", "for 4 days", "for a week", "for months". Here is how those map on.

Three or four days, otherwise well. This is inside the acute band. If you are drinking, keeping fluids down, have no blood, no fever, no severe pain, have not had antibiotics recently and do not have IBD or a weakened immune system, you have none of the features the guideline's testing recommendations are built around.

A week. You are crossing from acute into prolonged. If it is clearly improving, fine. If it is not, a GP call is reasonable, particularly if you have travelled, eaten something others also got ill from, or are losing weight.

Two weeks and beyond. Persistent diarrhoea is no longer the "wait it out" category. It is when parasites, C. difficile and the non-infectious causes start being looked for.

Months. This is chronic diarrhoea and needs investigating, even if you feel otherwise fine. British guidance lists the features that make an organic cause more likely: diarrhoea of less than three months' duration, predominantly nocturnal or continuous rather than intermittent diarrhoea, and significant weight loss (Arasaradnam 2018). Note the first of those. A new change that has lasted weeks is more concerning to a clinician than a pattern that has been the same for ten years.

It also helps to know what sits on the ordinary end of the list. The same guideline's box of common causes of chronic diarrhoea includes IBS with diarrhoea and bile acid diarrhoea, but also everyday dietary causes (poorly absorbed FODMAPs, lactase deficiency, sugar alcohols such as sorbitol in chewing gum and soft drinks, caffeine, excess alcohol and excess liquorice) and medicines (antibiotics, particularly macrolides, NSAIDs, magnesium-containing products, metformin and gliptins, and some cancer drugs) (Arasaradnam 2018). That is not a licence to stop anything you are prescribed. It is a list worth reading before an appointment, because "I started magnesium in March" is exactly the kind of detail that saves an investigation.

One person in r/ibs described a month or two of mostly diarrhoea, then feeling "spacey" and nearly fainting in the heat, and waiting weeks for insurance to come through before seeing anyone (r/ibs thread). That combination, weeks of liquid stool plus near-fainting, is exactly where the clock stops mattering. Dizziness that makes you feel you might pass out is its own reason to be seen. Faintness that comes on around a bowel movement itself is a different mechanism, covered in cold sweats before a bowel movement.

The things that skip the clock entirely

Some features change the answer on day one. The IDSA guideline recommends stool testing for bacterial causes (Salmonella, Shigella, Campylobacter, Yersinia, C. difficile and Shiga toxin-producing E. coli) in people whose diarrhoea comes with fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or signs of sepsis. It also recommends considering C. difficile testing in people over 2 with diarrhoea following antibiotic use, and a broad work-up in people with weakened immune systems (Shane 2017).

In plain terms, see a doctor promptly, rather than waiting for a duration band, if type 7 comes with:

• Blood in or on the stool, or black, tarry stool.
• Fever, shivering or feeling generally very unwell.
• Severe abdominal pain, or a tender, swollen belly.
• Signs of dehydration you cannot correct: unable to keep fluids down, dizziness or faintness on standing, confusion.
• Antibiotics in the last two to three months.
• A weakened immune system, from illness or from medicines such as steroids, immunosuppressants or biologics.
• Crohn's disease or ulcerative colitis, where watery stool can be a flare, an infection, or both.
• Pregnancy, older age or frailty, where there is less margin and, as the next sections show, dehydration is harder to spot.

A stool test is also something you can help get right. Labs want liquid. The IDSA guideline describes the optimal specimen for infectious diarrhoea as "a diarrheal stool sample (ie, a sample that takes the shape of the container)" and says a single specimen is enough for C. difficile, because multiple specimens do not increase yield (Shane 2017). A thread in r/UlcerativeColitis asked exactly how to transfer two weeks of fully watery stool from a collection hat into a sample pot (r/UlcerativeColitis thread). The honest answer is that it varies by kit and by test: use the device you were given, respect any fill line, and phone the lab if the kit clearly was not designed for liquid. They get asked this constantly.

Type 7 after antibiotics: the C. difficile question

New watery diarrhoea after antibiotics is the scenario where a stool test matters most, and it is also where a very confident piece of misinformation circulates. In an r/ibs thread from someone with sudden watery diarrhoea two days after finishing a course of amoxicillin-clavulanate (Augmentin), one reply stated flatly that Augmentin "shouldn't cause c diff" (r/ibs thread).

That is not what the evidence shows. Two independent meta-analyses of community-acquired C. difficile infection, both published in 2013, pooled observational studies and ranked antibiotic classes against no antibiotic exposure:

Sources: Brown 2013, Deshpande 2013.

Penicillins sit in the lower-risk group, but lower-risk is not no-risk: both analyses put their odds at roughly two and a half to three times those of no antibiotic, with confidence intervals that stay well clear of 1. Two caveats keep this honest. These are odds ratios from observational studies, not absolute risks, so they tell you which antibiotics carry more risk relative to each other, not your personal chance of infection. And Brown's analysis rests on seven studies, while Deshpande reported high heterogeneity overall (I² of 95%), so the exact multipliers are soft even where the direction is clear.

The practical point is simple. If new type 7 starts during or within a couple of months of any antibiotic, say so when you call. The IDSA guideline explicitly asks for C. difficile testing in travellers treated with antibiotics in the preceding 8 to 12 weeks (Shane 2017), which gives a sense of how long the window runs.

This matters even more with IBD. A review from a US IBD centre reported that C. difficile both mimics and precipitates IBD flares, that most IBD patients who catch it do so as outpatients, and that in their own centre's experience over half of infected IBD patients needed hospital admission, with colectomy rates that "may approach 20%" (Issa 2008). That colectomy figure is one centre's experience from the era of the epidemic strain, so read it as a reason for vigilance rather than a current risk estimate. The review's clinical point is the durable one: treating what looks like a flare with steroids, without checking for C. difficile, can make things worse.

The water you are losing: dehydration, honestly

Liquid stool is, by definition, water leaving your body, and dehydration is the most immediate risk of a run of type 7. The awkward truth is that it is hard to judge by looking, even for clinicians.

A systematic review of the bedside examination for low blood volume in adults found that in patients with vomiting, diarrhoea or reduced intake, few physical findings had proven usefulness. A dry armpit modestly supported the diagnosis (positive likelihood ratio 2.8), and moist mucous membranes and a tongue without furrows argued against it (negative likelihood ratio 0.3 for both). Capillary refill and poor skin turgor, the "pinch the back of your hand" test, had no proven value in adults. The authors concluded that when certainty matters, clinicians should check blood electrolytes, urea and creatinine (McGee 1999). The same review found that for blood loss, the most useful signs were severe dizziness on standing or a pulse rise of 30 beats per minute or more; that part was about bleeding, not diarrhoea, but it is why feeling faint when you stand up is taken seriously.

In older adults it is worse. A study of 188 UK care home residents compared 49 commonly used signs and symptoms of dehydration against a blood test and found that none of them usefully discriminated between residents who were and were not dehydrated (Bunn 2019). One important caveat: that study measured low-intake dehydration, the water-loss kind from not drinking enough, not the salt-and-water loss that diarrhoea causes. It is included here for one narrow point: in frail older people, "they look fine" is not reassurance.

So, practically, the useful questions are the ones you can answer:

• Can you keep fluids down? If vomiting means nothing stays down, oral rehydration is not working.
• What happens when you stand up? Feeling faint or needing to sit back down is a signal, not something to push through.
• Are you thinking clearly? Confusion, particularly in an older relative, is a reason to be seen urgently.
• Is this a high-risk body? Very young or very old, pregnant, frail, kidney disease, or medicines that affect fluid balance.

If you take regular medicines for blood pressure, diabetes, heart failure or kidney problems, some of them may need adjusting during a dehydrating illness. That is a question for your prescriber or pharmacist, ideally asked before it happens. Do not stop or change anything on your own.

A UC thread captured the other side of dehydration: someone on steroids, days into loose watery stools, sipping an electrolyte mix and still exhausted, asking whether that was the diarrhoea or the disease (r/UlcerativeColitis thread). Probably both, and there is no way to separate them from the outside, which is part of why IBD teams want to hear about runs of liquid stool rather than have you manage them alone.

What to drink: oral rehydration solution, sports drinks, water

The guideline position is clear. The IDSA recommends reduced-osmolarity oral rehydration solution (ORS) as first-line therapy for mild to moderate dehydration in infants, children and adults with acute diarrhoea from any cause (a strong recommendation on moderate-quality evidence), with intravenous fluids reserved for severe dehydration, shock, altered mental state or failure of ORS. A table in the same guideline lists apple juice, Gatorade and commercial soft drinks as popular beverages that should not be used for rehydration (Shane 2017).

The trial evidence in adults is thinner and does not fully agree. A double-blind trial randomised 75 adults admitted to a community hospital with viral gastroenteritis to Gatorade, Pedialyte or a new oral rehydration solution for 48 hours. Sixty completed it (a 20% dropout, which the authors flag). Stool frequency, consistency and body weight improved in all three groups with no difference between them. But low potassium was seen in 7, 10 and 8 Gatorade patients at admission, 24 and 48 hours, against 2, 2 and 1 on Pedialyte; the authors noted that hypokalaemia persisted only in the Gatorade group. Low sodium turned up in all three groups. The trial was funded in part by the US National Institutes of Health; PubMed also tags it as receiving non-government support that it does not name, and we could not read a conflict-of-interest statement (Rao 2006).

Plain water alone replaces water but not the salts that liquid stool carries out, which is why ORS exists. Many people in IBS communities have strong brand preferences and intolerances: in one r/ibs thread about electrolyte drinks, people listed product after product that upset their stomach or gave them headaches (r/ibs thread). Products marketed for hydration vary a lot in sugar and salt, and not all of them are oral rehydration solutions. A pharmacist can tell you which ones on the shelf actually are. We are not giving volumes or recipes here; if you are losing enough fluid to need a plan, that plan should come from a clinician who knows your health.

Antidiarrhoeal medicines: what the guidelines say, not what to take

This is not advice to take or avoid anything, and doses are for your pharmacist or doctor. What is useful to know is where the guidelines draw lines, because those lines are about safety.

The IDSA guideline says antimotility, antinausea or antiemetic medicines can be considered once a person is adequately hydrated, and are not a substitute for fluid and electrolyte replacement. It says loperamide may be given to immunocompetent adults with acute watery diarrhoea, but should be avoided at any age in suspected or proven cases where toxic megacolon may result in inflammatory diarrhoea or diarrhoea with fever, and should not be given to children under 18 with acute diarrhoea (Shane 2017).

In practice that means: type 7 with blood or fever is not a situation for self-treating with an antidiarrhoeal, and if you have IBD, ask your team before using one during what might be a flare. Our IBS-D travel guide covers what regulators have said about loperamide at doses well above the label.

One more reason not to rush past a bad bout of infectious type 7. In a meta-analysis of 45 studies following 21,421 people after infectious enteritis, 10.1% met criteria for IBS at 12 months, and risk was higher in women, in people given antibiotics during the enteritis, and with more severe illness (Klem 2017). One person in r/ibs traced three years of liquid stool that "feels like peeing" back to a Campylobacter infection, worsened by another infection the following year (r/ibs thread). If type 7 started with a gut infection and never fully stopped, tell your doctor about that infection. It changes what they consider.

Why type 7 at 3am is different: secretory and osmotic diarrhoea

Liquid stool happens by two broad routes. Either something in the gut is drawing water in (osmotic), or the gut lining is pumping fluid out (secretory). Knowing which one fits your pattern helps explain why clinicians ask the questions they do.

In osmotic diarrhoea, poorly absorbed molecules, such as lactose in someone who lacks lactase, hold water in the gut by osmosis. In secretory diarrhoea, the lining actively secretes chloride and water follows; this is the mechanism behind cholera and some other infections, and parts of it contribute to some forms of chronic watery diarrhoea (Camilleri 2017). The classic lab distinction is the stool "osmotic gap": in secretory diarrhoea, stool osmolality is almost entirely accounted for by salts, while in osmotic diarrhoea there is an unexplained gap left by the poorly absorbed molecules.

That review is candid about the limits. It says the osmotic/secretory classification "has never been validated in a clinical study", and that clinical studies suggest chronic watery diarrhoea frequently has a major motility component, with rapid transit limiting contact time between the stool and the lining (Camilleri 2017). Real diarrhoea is usually a mix.

Still, the idea behind the distinction survives as a useful clinical clue: what happens when you are not eating. The reasoning is that diarrhoea driven by what is in the gut should quieten when nothing is going in. The British guideline notes, for example, that bile acid diarrhoea after ileal surgery typically occurs after meals and usually responds to fasting (Arasaradnam 2018). Diarrhoea that carries on through the night, when you have not eaten for hours, points somewhere else. That is why the same guideline lists predominantly nocturnal or continuous diarrhoea among the features suggesting an organic cause.

This is the practical takeaway: if you are waking from sleep to pass liquid stool, write that down separately from morning urgency. They are different signals. Our post on IBS waking you at night covers why "night symptoms mean it is not IBS" is only half true, and what distinguishes the two.

Microscopic colitis: weeks of type 7 and a normal-looking colonoscopy

If one condition deserves to be called "the type 7 disease", it is microscopic colitis. Its defining symptom is chronic watery, non-bloody diarrhoea, and its defining trap is that the colon usually looks normal or nearly normal on colonoscopy. The diagnosis is made under the microscope, from biopsies (Miehlke 2021).

The 2021 European guideline, from United European Gastroenterology and the European Microscopic Colitis Group, sets out what it looks like:

• Chronic watery, non-bloody diarrhoea was reported by 84% to 100% of patients across 22 studies.
• In a large Danish study of 539 patients, the average was 6 to 7 bowel movements a day.
• Common companions were faecal urgency (55%), nocturnal stools (35.3%) and faecal incontinence (26.3%).
• The risk is higher in women (pooled odds ratio 2.52), and in the three largest European studies about 72% of patients were female.
• In people meeting criteria for a diarrhoea-predominant functional disorder, two meta-analyses found underlying microscopic colitis in about 9% (95% CI 4.5% to 14.9%).

(Miehlke 2021)

The British guideline quotes a slightly different pooled prevalence, 9.8% (95% CI 4.4% to 17.1%) in people meeting criteria for IBS with diarrhoea (Arasaradnam 2018). These come from overlapping but not identical meta-analyses, and the European guideline warns that not all included studies used current diagnostic criteria, so heterogeneity is high. Roughly one in ten is the fair summary. The European guideline's own statement is that microscopic colitis should be ruled out in people who fulfil the criteria for functional bowel disease, especially with risk factors or when IBS treatment is not working.

Patient communities know this condition well. A widely upvoted r/ibs post titled "Think you have IBS-D? It might be microscopic colitis instead!" drew replies from several people diagnosed years into what they had been told was IBS (r/ibs thread). In the long-running Bristol scale thread, someone who had been at "type 6 or 7 for over 2 years" later reported being diagnosed with microscopic colitis after seeing a gastroenterologist (r/ibs thread). Those are individual stories, not evidence of how often it happens, but they match the guideline's point.

Certain medicines are associated with microscopic colitis, and this is one place where two sources disagree in a way worth showing. The European guideline states that chronic or frequent use of proton pump inhibitors (PPIs), NSAIDs or SSRIs is associated with an increased risk. A Dutch nested case-control study found a wider initial list, with adjusted odds ratios ranging from 2.5 for ACE inhibitors to 7.3 for PPIs in the year before diagnosis. But once the authors accounted for diagnostic delay, only NSAIDs, PPIs, low-dose aspirin and ACE inhibitors remained, and against colonoscopy-negative controls only PPIs (odds ratio 10.6, 95% CI 1.8 to 64.2) and NSAIDs (5.6, 1.2 to 27.0) did. The authors concluded that the associations with the other drugs, SSRIs included, were probably explained by those medicines worsening diarrhoea rather than causing the condition (Masclee 2015). Note how wide those last confidence intervals are: the direction is clear, the size is not.

We cannot settle the SSRI question from these two sources, and neither should you. Do not stop any medicine because of this list. If you have chronic watery stool and take any of these, tell your doctor, who can weigh it properly.

Type 7 when you are actually constipated: overflow

This one confuses people more than any other, and it is where the Bristol scale can actively mislead. Liquid stool can be a sign of constipation: a mass of hard stool stuck low in the bowel, with liquid from higher up seeping past it.

British guidance lists overflow diarrhoea among the common causes of chronic diarrhoea, and recommends that faecal impaction with overflow diarrhoea should be considered especially in older people, using clinical judgement and a rectal examination rather than marker studies (Arasaradnam 2018). The same guideline notes the people most often affected: those with cognitive or behavioural difficulties, learning disabilities, or neurological or spinal disease. It is also relevant for anyone on medicines that slow the gut.

Patients describe the milder, everyday version vividly. In an r/ibs thread about passing "the entire Bristol stool chart in one sitting", one reply described being so blocked that only liquid gets past the hard stool, and several people described a "plug" followed by liquid behind it (r/ibs thread). Not all of that is impaction; a hard stool followed by a loose one in the same visit is common in IBS with mixed bowel habits. But the pattern of hard pieces, straining, a sense of never emptying, then liquid is worth describing in exactly those words, because it points towards treating constipation, and antidiarrhoeal medicine is the wrong tool for it. Our type 6 post covers the milder "constipated diarrhoea" version, and Crohn's with constipation rather than diarrhoea covers why the assumption that IBD always means diarrhoea misleads.

Type 7 with Crohn's disease or ulcerative colitis

If you have IBD, a run of type 7 is more than a comfort problem, and the scoring systems your team uses reflect that.

• In Crohn's, the Harvey-Bradshaw Index counts liquid or soft stools one point each with no ceiling, so a day of type 7 can dominate the score on its own. Our Harvey-Bradshaw Index guide explains why that makes the score blunt, and why deciding what counts as "liquid or soft" and sticking to it matters.
• In ulcerative colitis, stool frequency against your own normal and rectal bleeding are the two items of PRO-2, explained in our PRO-2 guide. Frequent bloody stools are one of the markers of severe activity that the hospital thresholds are built on; our post on when to go to hospital with a UC flare sets those out.
• Blood in type 7 has its own logic in UC. The pattern, not the estimated volume, is what your team can use, as covered in how much blood in stool is normal with UC.
• C. difficile can mimic or trigger a flare, as above (Issa 2008). A stool test is often part of assessing a flare for exactly that reason.

For the question of whether a run of loose stools is a flare at all, how do I know if my ulcerative colitis is flaring and how to tell if you are in a Crohn's flare cover the symptom-versus-inflammation problem in depth.

Type 7 on purpose: bowel prep

There is one situation where type 7 is the goal. Bowel preparation for a colonoscopy is designed to produce liquid stool until what comes out is clear enough for the endoscopist to see the lining. People understandably try to read their own last stool to judge whether they are "done".

The evidence says that reading is unreliable, with one useful exception. In a study of 429 outpatients at three US endoscopy units, patients' descriptions of their last rectal effluent showed only slight agreement with the endoscopist's assessment of the prep (kappa 0.067). But patients who reported their last output as brown liquid or solid had a 54% chance of a fair or poor preparation (Fatima 2010). A smaller 2024 study of 70 patients found thin yellow fluid was the most common final effluent, and thin, clear fluid was significantly associated with an adequate prep (Patwa 2024).

So "it is type 7 now" is not the same as "it is ready". Liquid that is still brown suggests more work to do; clear or nearly clear liquid is the better sign. If you are unsure on the morning, phone the endoscopy unit rather than guessing. Our guide to colonoscopy prep with Crohn's covers the practical side, most of which applies to anyone.

A worked example: one week of type 7, recorded two ways

Priya is 38, has IBS with diarrhoea that normally sits around type 5 and 6, and finished a course of antibiotics for a chest infection nine days ago. Then her stools go liquid.

Recorded the usual way, as the worst type each day:

That record says "bad week". It cannot say whether this is her normal IBS on a bad run or something new.

Recorded per stool, with three extra fields:

The second record tells a clinician in ten seconds that frequency is climbing well above three a day, that she is waking at night to pass liquid, that she felt lightheaded on standing, and that she finished antibiotics within the last two weeks. That combination is exactly what the IDSA guidance flags for C. difficile consideration (Shane 2017), and "my IBS is bad" would never have surfaced it. Priya's week is illustrative, not a real case, but every field in it maps to a question a clinician will ask.

How to record type 7 so the count survives

Four rules, each tied to something above.

One entry per stool, not one per day. The diarrhoea definition is a count per 24 hours (Shane 2017), and the Crohn's score counts liquid stools individually. A daily "worst type" field keeps the type and throws away the number. This is the single most common way liquid-stool records lose their value.

Mark night-time episodes separately. Waking from sleep to pass liquid stool is a different signal from urgency after breakfast, and guidance treats predominantly nocturnal diarrhoea as pointing towards an organic cause (Arasaradnam 2018).

Note the context once, at the start of the run. Antibiotics in the last three months, travel, a new medicine, a stomach bug in the household, anything unusual you ate. Those are the questions that decide which tests make sense.

Record the warning signs as yes/no, every time. Blood, fever, lightheadedness on standing. A yes on any of them is not a tracking task; it is a reason to see a doctor promptly.

Clairop's log is built around exactly this: each bowel movement is one entry with a Bristol type, and urgency, blood and whether it woke you overnight are one tap each beneath it, so the per-day count and the night-time episodes are kept rather than summarised away. The how it works page shows how the doctor report then presents mean movements per day against your own baseline alongside days with blood and overnight episodes. For what clinicians actually read in a handover, see the symptom tracker for your doctor.

Myths about Bristol type 7

"Type 7 is an SOS: your gut lining is inflamed." A version of this circulates on social media. Type 7 describes water content. Inflammation is a separate question answered by tests: calprotectin for IBD, biopsies for microscopic colitis. Liquid stool can come from osmotic, secretory or motility mechanisms with no inflammation involved (Camilleri 2017), and some genuinely inflammatory conditions, such as microscopic colitis, are routinely missed by the very test people assume would catch them.

"The chart tells you your transit time." Stool form correlates with transit, moderately (Lewis 1997). It does not convert into hours, and we could not find a source for the per-type hour ranges many charts print.

"Penicillins do not cause C. difficile." Two meta-analyses say they do raise the odds, less than some other classes but clearly above no antibiotic (Brown 2013, Deshpande 2013).

"My calprotectin is normal, so it is not colitis." Not for microscopic colitis (Miehlke 2021).

"Liquid stool means diarrhoea medicine." Not when there is blood or fever, not in children, and not when the liquid is overflow from constipation (Shane 2017, Arasaradnam 2018).

"Looser stool means a healthier, more diverse microbiome." One page ranking for this search says faster transit goes with higher microbial richness. The Gut study that looked at this directly found the opposite: across 53 healthy women, stool consistency was negatively correlated with species richness, meaning richness fell as stools got looser (Vandeputte 2016). It is a correlation in healthy volunteers, it says nothing about which causes which, and it is not a reason to worry about your microbiome after a bad week. But the claim runs backwards.

"Sports drinks are useless" and "sports drinks are just as good". Both are too confident. The guideline says use oral rehydration solution; one small adult trial found a sports drink roughly as effective in mild illness, with more low potassium (Shane 2017, Rao 2006).

When to see a doctor promptly

Type 7 on its own, for a day or two, while you feel well and can drink, is usually something to ride out while keeping fluids up. These alongside it are reasons to be seen promptly rather than to keep tracking:

• Blood in the stool, or black, tarry stool.
• Fever, or feeling generally very unwell.
• Severe or worsening abdominal pain, or a swollen, tender belly.
• Signs of dehydration: unable to keep fluids down, faint or dizzy on standing, confusion, or very little urine.
• Antibiotics within the last two to three months.
• A weakened immune system, or Crohn's disease or ulcerative colitis.
• Waking at night to pass liquid stool.
• Unintentional weight loss.
• Diarrhoea lasting more than a week without clear improvement, or any new change in bowel habit lasting weeks, especially over the age of 50 or with a family history of bowel cancer or IBD.
• Accidents or near-misses, which are worth naming even though they are hard to say.

If you are faint, confused, cannot keep any fluid down, or have heavy bleeding, that is same-day or emergency care, not a GP appointment next week.

The honest bottom line

Bristol type 7 means liquid stool with no solid pieces. It tells you the stool carried a lot of water, and nothing about why. The why comes from the count per day, how long it has gone on, what time of day it happens, and what came with it.

A couple of days of type 7 while you feel well is common and usually passes. Three or more a day is diarrhoea. More than a week without clear improvement deserves a call; more than a month deserves investigation, including a proper look for microscopic colitis, which a normal calprotectin does not rule out. Blood, fever, severe pain, dehydration, recent antibiotics, night-time episodes, IBD or a weakened immune system mean see a doctor promptly, whatever day it is.

And if you are going to write anything down, write down every stool, not the worst one. The count is the part that clinicians need and the part that most records lose.