InvestigationsPotential resultsClinical management plan: abnormal results
Dietary assessmentExcessive dietary fibre intake
  1. Refer to dietitian for detailed dietary review and advice.

  2. Pelvic floor and toileting exercises (page 18).

Rectal examinationHaemorrhoidsStool bulking/softening agent.
± short-term topical local anaesthetic.
Anal lesion Rectal lesionRefer urgently to a GI surgeon.
Refer for a flexible sigmoidoscopy within 2 weeks.
Flexible sigmoidoscopyAnorectal ulcerDetermine patient is not on nicorandil for angina.
NeoplasticRefer urgently to the appropriate oncology team requesting an appointment within 2 weeks.
Rectal mucosal prolapseRefer to a GI surgeon.
Traumatic ulceration/solitary rectal ulcer syndromeRefer to a gastroenterologist.
If radiation-ulceration relatedDo not biopsy
  1. Sucralfate enemas.

  2. Consider stool bulking/softening agent.

  3. Antibiotics.

  4. Consider hyperbaric oxygen therapy.

  5. Refer to a specialist centre.

Carpet villous adenomaRefer for endoscopic removal.
Newly diagnosed neoplasmRefer to the appropriate oncology team requesting an appointment within 2 weeks.
  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.

OGD and D2 aspirate and/or glucose hydrogen (methane) breath testSIBOTreatment for SIBO (page 17).
  • GI, gastrointestinal; IBD, inflammatory bowel disease; OGD, oesophago-gastroduodenoscopy; SIBO, small intestinal bacterial overgrowth.