OBJECTIVES: A popular topic for Clinical Outcomes Assessments (COAs) is questions concerning bowel conditions. In English, a varied and colourful vocabulary is used to describe and differentiate between forms of bowel excretions; however, during Linguistic Validation, difficulties can arise ensuring that linguists in different countries understand the source English consistently. Here we will look at two commonly used terms: stool and bowel movements. METHODS: The terms ‘stool’ and ‘bowel movement’ and their meaning were investigated across 21 languages, including English. RESULTS: In English ‘stool’ refers to a piece of faeces excreted from the anus, while ‘bowel movement’ is more ambiguous. For example, in a COA about children with Crohn’s Disease parents were asked if they had “observed their child having a bowel movement”. After clarification from the author, here they were interested only in defecation. Whilst in another COA for the same disease area the author stipulates within the questionnaire itself that any form of anal excretion should be counted as a ‘bowel movement’. 65% of languages examined agreed with the English explanation of ‘stool’; with 30% understanding it to mean any excretion from the anus; and 5% believing it to refer to the act of defecation. While of the 21 languages only 20% thought ‘bowel movement’ concerns the anal expulsion of any substance; 70% of languages understood this phrase to mean the act of defecation; with 5% thinking it referred to the faeces passed and the remaining 5% seeing it as both the faeces and the act of passing it.  CONCLUSIONS: Due to the varying interpretations between different countries and individuals it is demonstrated that it is important to ensure the intention of the source is clearly specified so as to ensure conceptual equivalence across all languages, and global comprehension by subjects.