InvestigationsPotential resultsClinical management plan: abnormal results
1st Line
Dietary assessmentExcess/deficient fibre intake/resistant starch
Inadequate fluids
Referral to dietitian and ask patient to complete 7 day dietary diary in advance. Dietitian to assess food diary to determine dietary fibre intake.
Give appropriate advice.
2nd Line
Abdominal X-rayConstipationSee ‘constipation’ (page 6).
Faecal loading
  1. Full bowel clearance, eg, Picolax, Klean-Prep, Moviprep.

  2. Maintenance bulk laxative.

  3. Correct positioning on lavatory and pelvic floor exercises (page 18).

OGD and D2 aspirate and/or glucose hydrogen (methane) breath testSIBOTreatment for SIBO (page 17).
Flexible sigmoidoscopyNewly diagnosed neoplasmRefer urgently to the appropriate oncology team, requesting an appointment within 2 weeks.
Newly diagnosed IBD
  1. Send stool culture.

  2. If mild or moderate, refer within 2 weeks to a gastroenterologist.

    If severe, this is an emergency—discuss immediately with a gastroenterologist.

Rectal examinationPelvic floor dysfunction (page 17)
Lax sphincter muscle
  1. Pelvic floor and toileting exercises (page 18).

  2. Stool bulking ± antidiarrhoeal agent.

  3. Antidiarrhoeal agent ± stimulant laxative suppositories/enemas.

  4. Referral for biofeedback (page 18).

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