Investigations	Potential results	Clinical management plan: abnormal results
Dietary assessment	Excessive dietary fibre intake	Refer to dietitian for detailed dietary review and advice. Pelvic floor and toileting exercises (page 18).
Rectal examination	Haemorrhoids	Stool bulking/softening agent. ± short-term topical local anaesthetic.
	Anal lesion Rectal lesion	Refer urgently to a GI surgeon.
	Anal lesion Rectal lesion	Refer for a flexible sigmoidoscopy within 2 weeks.
Flexible sigmoidoscopy	Anorectal ulcer	Determine patient is not on nicorandil for angina.
	Neoplastic	Refer urgently to the appropriate oncology team requesting an appointment within 2 weeks.
	Rectal mucosal prolapse	Refer to a GI surgeon.
	Traumatic ulceration/solitary rectal ulcer syndrome	Refer to a gastroenterologist.
	If radiation-ulceration related	*Do not biopsy* Sucralfate enemas. Consider stool bulking/softening agent. Antibiotics. Consider hyperbaric oxygen therapy. Refer to a specialist centre.
	Carpet villous adenoma	Refer for endoscopic removal.
	Newly diagnosed neoplasm	Refer to the appropriate oncology team requesting an appointment within 2 weeks.
	IBD	Send stool culture. If mild or moderate, refer within 2 weeks to a gastroenterologist. If severe, *this is an emergency*—discuss immediately with a gastroenterologist.
OGD and D2 aspirate and/or glucose hydrogen (methane) breath test	SIBO	Treatment for SIBO (page 17).

GI, gastrointestinal; IBD, inflammatory bowel disease; OGD, oesophago-gastroduodenoscopy; SIBO, small intestinal bacterial overgrowth.