Synopsis
Characterise a new bowel-habit change precisely, identify alarm and obstruction features, use current FIT recommendations correctly, and retain responsibility until definitive investigation or symptom resolution.
- Define baseline stool form and frequency, then record the exact new pattern and its duration.
- Vomiting, distension and inability to pass stool or flatus suggest obstruction and need emergency assessment.
- Weight loss, rectal bleeding, iron deficiency or an abdominal or rectal mass increase cancer concern.
Key red flags
Progressive abdominal distension, vomiting, absolute constipation, severe pain, peritonism or systemic compromise may represent large-bowel obstruction or perforation and needs same-day emergency surgical assessment.
Investigation priorities
look for distension, mass, tenderness, faecal loading and low rectal pathology
Management branches
A 67-year-old has six weeks of progressively looser stool, urgency and 4 kg weight loss. There is no mass or obstruction on examination, haemoglobin is 116 g/L and quantitative FIT returns 16 micrograms haemoglobin per gram.
- Confirm stable physiology and ask directly about vomiting, progressive distension and passage of flatus; their absence makes immediate obstruction less likely in this case.
- Establish that the looser stool is a six-week change from baseline and document urgency, nocturnal symptoms, blood, pain, appetite, weight, medicines, travel and family history.
A 54-year-old has new looser stool for seven weeks, FIT 4 micrograms per gram, no mass or anaemia, but symptoms remain unexplained at the first review.