Constipation and Fluctuating Bowel Habits (Inc Suspected IBS)

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply to referral standards and include in particular:

  • Duration of symptoms
  • Pattern and severity of symptoms especially nocturnal symptoms
  • Past history especially of bowel or pelvic surgery
  • Description of bowel habits including blood loss, pain
  • Medications especially use of opioids

Tests

Initial work up:

  • FBE
  • ESR or CRP
  • TFTs
  • Folate, B12
  • Iron studies
  • Creatinine and electrolytes
  • LFT
  • Plain abdominal x-ray
  • Stools M,C&S, parasites in patients with an element of diarrhoea

Interim/GP management

To refer a patient with this condition, please see the Gastroenterology clinic page for the full referral process and templates.

Recommended pre-referral treatment

Lifestyle Changes:  Increase dietary fibre if lacking and fluid intake.

Medical Management:

  • Bulk forming laxatives e.g. Metamucil – must maintain adequate fluid intake and will likely take several days for effect
  • Stimulant laxatives e.g. coloxyl with senna or bisacodyl – increase intestinal mobility but not suitable for intestinal obstruction
  • Osmotic laxatives e.g. macrogol, lactulose – increase the water in the large bowel but not suitable for intestinal obstruction
  • Consider pelvic floor dysfunction and pelvic floor physiotherapist management

For more information please see the Tasmanian Health Pathways website.

Emergency

Urgent / category 1

When combined with any of the following alarm symptoms:

Semi-urgent / category 2

Rectal bleeding

Change in bowel function in recent months

Routine / category 3

Long-standing bowel disturbance or suspected Irritable Bowel Syndrome (IBS) without alarm symptoms

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

GESA Guideline: Irritable Bowel Syndrome (2006)

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6426 5115
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6430 6691
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6222 8919

Urgent:

We will endeavour to see these patients within four weeks

Urgent referrals should be accompanied by a phone call to the clinic and the relevant doctor for urgent assessment, or patient should be directed immediately to the Emergency Department.

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment