Investigations | Potential results | Clinical management plan: abnormal results |
---|---|---|
1st Line | ||
Routine AND additional blood screen (pages 2–3) | Abnormal results | Follow treatment of abnormal blood results (pages 2–3). |
Rectal examination Anoscopy Flexible sigmoidoscopy | Pelvic floor dysfunction (page 17) with radiation proctopathy and faecal incontinence/leakage OR Anal sphincter defect |
|
Stool consistency: type 6–7 | See ‘diarrhoea’ (page 7). | |
Constipation with overflow diarrhoea | See ‘constipation’ (page 6). | |
Mucus leakage | See ‘mucus discharge’ (page 9). | |
Mucosal prolapse | Routine referral to a GI surgeon. | |
Unrelated to radiotherapy (eg, childbirth, previous sphincter surgery, haemorrhoidectomy, idiopathic) | Refer to a specialist team for management of faecal incontinence. | |
2nd Line | ||
Endo anal ultrasound AND Anorectal physiology | Muscular incoordination or inadequate function | Pelvic floor and toileting exercises (page 18) Bulking agent (Normacol (Norgine, Harefield, UK) or loperamide. Biofeedback (page 18). |
Significant sphincter defect | Discuss with supervising clinician and routine referral to GI surgeon for consideration of sacral nerve or tibial nerve stimulation. |
GI, gastrointestinal.