Constipation and Fluctuating Bowel Habits (Inc Suspected IBS)

This condition is treated in the Gastroenterology clinic.

Pre-referral work-up

History

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

Medical management to date (document treatments offered and efficacy including failed dietary/pharmacology intervention).

Tests

Pathology:

FBC

LFT

U&E

TSH

TFTs (if TSH abnormal)

Iron studies results

Imaging:

Any relevant

Investigations:

Nil

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 HealthPathways Tasmania website.

GESA Guideline: Irritable Bowel Syndrome (2006)

Clinic appointments

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

Emergency

🚩Potentially life-threatening symptoms suggestive of:

• acute upper GI tract bleeding
• acute severe lower GI tract bleeding
• oesophageal foreign bodies/food bolus
• bowel obstruction
• abdominal sepsis
• Acute Severe Colitis - see note

🚩 Severe vomiting and/or diarrhoea with dehydration
🚩 Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
🚩 Biliary sepsis (to be referred to a centre with ERCP service)

Note -Acute severe colitis as defined by the Truelove and Witts criteria - all patients with greater than or equal to 6 bloody bowel motions per 24 hours plus at least one of the following:

• temperature at presentation of over 37.8°C,
• pulse rate at presentation of over 90 bpm,
• haemoglobin at presentation of under 105 gm/l, CRP over 30mg/dl at presentation (or ESR over 30 mm/hr)

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Urgent (Category 1)

New onset constipation in patients over 50 years old or patients with any of the following concerning features, select those that apply:

• Gastrointestinal bleeding
• Abdominal pain/mass
• Family history of bowel cancer
• Weight loss greater than or equal to5% of body weight in previous 6 months
• Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women

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 (Category 2)

Refractory symptoms not responding to medical management without concerning features (as above) and affecting activities of daily living.

Availability

North

Launceston General Hospital
Level 3 - Specialist Clinics

Phone: 1300 977 694
Fax: 03 6777 5227

North West

All North West referrals are managed via Mersey Community Hospital
Phone: 03 6478 5222
Fax: 03 6441 5942

South

Wellington Clinics (Level 10)
Phone: 03 6166 0000
Fax: 03 6234 3982