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The Bristol Stool Scale or Bristol Stool Chart is a diagnostic medical tool used both in clinical and experimental settings, created to classify the shape and consistency of human stools into categories; the scale includes seven distinct categories.
The shape and consistency of feces depend on the time they spend in the colon, with a good statistical correlation.
The consistency of feces is also determined by the type of diet; in fact, a diet rich in fiber accompanied by plenty of water will result in softer and bulkier stools, while a fiber-poor diet will lead to more formed and concentrated stools.
Type 1: Hard lumps separated from each other, like nuts (difficult to pass); also referred to as goat stool.
Type 2: Sausage-shaped, but made up of individual lumps.
Type 3: Like a salami, but with cracks on its surface.
Type 4: Like a sausage or snake, smooth and soft.
Type 5: Soft separate pieces with clear-cut edges; easy to evacuate.
Type 6: Soft, fluffy pieces with jagged edges, mushy stools.
Type 7: Watery, no solid pieces. Completely liquid.

Fecalomas, especially if multiple, tend to cause pain in the lower quadrants of the abdomen. Abdominal discomfort usually presents shortly after a meal. It may also be accompanied by a sensation of rectal fullness, tenesmus, or colicky pain in the left iliac fossa. Due to the painful symptoms associated with eating, subjects often, sometimes unconsciously, voluntarily reduce their food intake, and consequently, weight loss becomes a fairly common symptom.
Some subjects also present accompanying nonspecific symptoms such as nausea, vomiting, and dehydration. Headaches, as well as a vague sense of malaise, are frequent symptoms. Due to the fecaloma, the rectosigmoid tends to dilate, and the hard fecal mass is not always plastic enough to be expelled through the patient's anal canal, which, due to pain, generally results in inadequate defecatory efforts. Sometimes, instead of a single large fecaloma, multiple masses of hard, rounded feces are found, which also fail to be expelled.
In some cases, patients paradoxically may experience diarrhea. In reality, this is the incontinence of small amounts of liquid or semi-formed feces. When the liquid feces from the proximal colon approach the fecaloma, they are pushed by intestinal peristalsis to overcome the obstacle of the fecal mass, which acts like a ball valve, forcing a small amount of fluid to pass around it, allowing it to be evacuated, which prevents complete obstruction.
The fecaloma, however, can also be asymptomatic.

The appearance of an anal fissure is usually due to constipation and/or diarrhea that persist over time. Often, the triggering event is represented by the passage through the anal canal of a large amount of stool or particularly hard stool (for example, fecalomas). In cases of constipation, the stools remain in the intestine longer than normal, harden, and upon defecation cause a small trauma to the anal wall. The recurrence of these events leads to the formation of the fissure. An essential role in the pathology of the fissure is played by the hypertonicity of the internal sphincter, which likely causes a localized "micro-ischemia" that slows down, and sometimes prevents, the proper healing of the ulceration. The loss of elasticity of the anal canal secondary to previous anal surgery may represent a predisposing factor.
Location
The posterior midline is involved in about 98% of males and 90% of females. Fissures and cracks in other locations should prompt consideration of other underlying disorders, such as Crohn's disease.
Symptoms and Signs
The characteristic symptom of the presence of an anal fissure is pain. Pain is the most common presenting symptom, occurring paroxysmally and in a burning manner. It is often described by the patient as excruciating and tearing. It typically appears with each defecation and tends to last from a few minutes to several hours after evacuation. Sometimes, it is associated with itching in the anal region. Some patients report the loss of a few drops of blood during evacuation, generally bright red in color. In rare cases, true rectal bleeding may occur. In many cases, there is an association with the presence of fistula, perirectal abscess, or hemorrhoidal disease. No familial or predispositional causes have been recognized.
Diagnosis

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Cutaneous larva migrans, also known as “creeping eruption” or “serpiginous dermatitis,” is the most common acquired tropical dermatosis. It presents as a serpiginous, itchy rash confined to the skin of the feet, arms, or buttocks.
It is caused by the transcutaneous penetration and subsequent migration of larvae from a hookworm, the Ancylostoma, a nematode that lives as a parasite in the intestines of dogs and cats. The most common is Ancylostoma braziliense, which is a parasite of both wild and domestic dogs and cats found in the central and southern United States, Central America, South America, and the Caribbean.
The cutaneous manifestations are due to a hypersensitivity reaction to the parasites and their products.
It is very common in tropical and subtropical geographical areas; however, the ease and increasing frequency of vacations in such areas have led to the disease no longer being confined to these geographical boundaries.
The life cycle of the parasites begins when animals infested with Ancylostoma excrete the microscopic eggs of the parasite in their feces: the eggs move from the animal's feces into the moist, warm, sandy soil (typical of tropical and subtropical regions) where they hatch and larvae are born.
Humans become infected with the larvae in areas that come into direct contact with contaminated soil (e.g., walking barefoot on the sand, lying on the beach). The larvae penetrate the skin due to their proteases after contact. Once they pass through the stratum corneum (the outermost layer of the epidermis and thus of the skin), they lose their natural cuticle and after a few days begin their migration, remaining limited to the epidermis (the superficial part of the skin), presumably due to a lack of enzymes (collagenases) that would allow them to cross the membrane separating the epidermis from the dermis (the basal membrane).