InvestigationsPotential resultsClinical management plan: abnormal results
1st Line
Routine AND additional blood screen (pages 2–3)Abnormal resultsFollow 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
  1. Pelvic floor and toileting exercises (page 18).

  2. Stool bulking ± antidiarrhoeal agent.

  3. Antidiarrhoeal agent ± stimulant laxative suppositories/enemas.

  4. Topical sympathomimetic agent (eg, phenylephrine).

  5. Perianal skin care (pages 19–20).

  6. Referral for biofeedback.

  7. Consider referral to a specialist centre for sacral nerve stimulation.

  8. Consider referral to a specialist centre for defunctioning surgery/sphincter repair.

Stool consistency: type 6–7See ‘diarrhoea’ (page 7).
Constipation with overflow diarrhoeaSee ‘constipation’ (page 6).
Mucus leakageSee ‘mucus discharge’ (page 9).
Mucosal prolapseRoutine 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
Anorectal physiology
Muscular incoordination or inadequate functionPelvic floor and toileting exercises (page 18)
Bulking agent (Normacol (Norgine, Harefield, UK) or loperamide.
Biofeedback (page 18).
Significant sphincter defectDiscuss with supervising clinician and routine referral to GI surgeon for consideration of sacral nerve or tibial nerve stimulation.
  • GI, gastrointestinal.