In order to determine the correct treatment pathway, it is essential to undertake a detailed assessment. Components must include an assessment of the persons general health, previous abdominal and colorectal surgery, medications, plus functional ability to reach the toilet, cognition and awareness of bowel sensations, and current bowel management.
Bowel diary and Food diary
The essential components for assessing any person with bowel symptoms should include a food diary, and a bowel diary.
Bristol stool chart
It is also vital to determine what type of stool the person is producing. The Bristol Stool Chart is a good tool to use:
|Bristol Stool Chart|
|Type 1||Separated hard lumps, like nuts (hard to pass).|
|Type 2||Sausage-shaped but lumpy.|
|Type 3||Like a sausage, but with cracks on the surface.|
|Type 4||Like a sausage or snake, smooth and soft.|
|Type 5||Soft blobs with clear cut edges.|
|Type 6||Fluffy pieces with ragged edges, a mushy stool.|
|Type 7||Watery, no solid pieces. Entirely liquid.|
Symptom impact scores
There are several tools available to assess bowels. Bowel dysfunction symptoms can be measured by a variation of different scores, some examples are NBD score, Cleveland Clinic Constipation Score, and Wexner score for fecal incontinence. The Bristol stool chart may be used for symptom description. There are also various tools which measure the impact of the bowel symptoms, including quality of life assessment.
In some people it is necessary to perform a rectal examination. This should be only undertaken by a specialist.
Once a comprehensive bowel assessment has been undertaken, treatments can be planned which identify any dietary and fluid modifications, or interventions aimed at altering stool consistency, and behaviour strategies aimed at regular toileting.
There are a number of ‘red flags’ which may be highlighted if an in-depth bowel assessment is undertaken. These may include reports of blood or mucus in the stools, bowel or rectal pain, spontaneous leakage without any sensation in the absence of neurogenic disease, and if any red flags are discovered during the assessment it is important to refer to the individual to their GP as soon as possible, and document this.