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	Pelvic floor and toileting exercises (page 18). Stool bulking ± antidiarrhoeal agent. Antidiarrhoeal agent ± stimulant laxative suppositories/enemas. Topical sympathomimetic agent (eg, phenylephrine). Perianal skin care (pages 19–20). Referral for biofeedback. Consider referral to a specialist centre for sacral nerve stimulation. Consider referral to a specialist centre for defunctioning surgery/sphincter repair.
	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).
Endo anal ultrasound AND Anorectal physiology	Significant sphincter defect	Discuss with supervising clinician and routine referral to GI surgeon for consideration of sacral nerve or tibial nerve stimulation.

GI, gastrointestinal.