InvestigationsPotential resultsClinical management plan: abnormal results
Dietary/lifestyle/medications assessmentInadequate fibre intake
Reduced general exercise
Drug induced, eg,
  • opioid

  • ondanestron

  • antimuscarinic

  • loperamide

  • iron supplement

Chronic constipation/evacuation disorder
  1. Dietary advice about healthy fibre and fluid intake.

  2. Lifestyle advice about daily exercise.

  3. Making time to have a toileting routine, correct positioning on the lavatory.

  4. Medications advice.

  5. Rectal evacuant (eg, glycerine suppositories).

  6. Bulk laxative ± rectal evacuant.

  7. Consider referral for biofeedback therapy (page 18).

  8. Consider use of probiotics.

Abdominal/rectal examinationAnal fissure
  1. Topical healing agent, eg, GTN or diltiazem gel (for 8 weeks).

  2. Stool bulking/softening agent ± short term topical local anaesthetic.

  3. If recurrent, consider referral for botulinum toxin treatment.

  4. If fissure not healed after 2 months, refer for surgical opinion.

Routine blood screen and additional blood screenDehydrationEncourage oral fluid intake.
  1. Repeat thyroid function test.

  2. Inform GP and follow management (pages 2–3).

Elevated calciumFollow management (page 2).
Abdominal X-rayFaecal loading/faecal impaction
  1. Full bowel clearance, eg, Picolax, Klean-Prep.

  2. Maintenance bulk laxative.

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

Transit studySlow GI transitDiscuss and refer to a gastroenterologist routinely.
Colonoscopy/CT pneumocolon if new onset
Flexible sigmoidoscopy for longstanding problems
Newly diagnosed neoplasmDiscuss and refer to oncology team, requesting appointment within 2 weeks.
Newly diagnosed IBDIf mild or moderate, refer within 2 weeks to a gastroenterologist. If severe, this is an emergency—discuss immediately with a gastroenterologist.
Anastomotic stricturingDiscuss with supervising clinician.
Anterior resection syndrome
  1. Pelvic floor exercises (page 18).

  2. Bulking agent.

  3. Antidiarrhoeal medication.

  4. Low-dose tricyclic/SSRI antidepressant.

  5. Consider referral for sacral nerve/tibial nerve stimulation.

  6. Consider referral to a GI surgeon for stoma formation.

  • GI, gastrointestinal; GP, general practitioner; GTN, glyceril trinitrate; IBD, inflammatory bowel disease.