Altered bowel habit Cheat Sheet (DRAFT) by med_panda

- Clarify what patients mean by diarrhoea.
- They may complain of frequent stools or of a change in consis­tency of the stools – stools have become loose or watery, or a pattern of bowel movement that’s different from their normal.
- Normal frequency ranges from three bowel movements daily to once every 3 day

- How long has this been happening? (acute <2wks)
- How many times do you visit the toilet to pass stool since then? How many times do you normally go?
- Can you describe your bowel movement? is it soft, firm, loose or watery?
- Any blood or mucous in the stool? (suggest inflam­matory bowel disease, invasive enteric infections eg. Shigella, Salmon­ella, campyl­oba­cter)
- Did you notice that your stool was paly, smelly or its difficult to flush? It stains the toilet bowl? (steat­orrhea/ fat malabs­orp­tion)
- Have you had problems with leaky stool, you cant control your toilet? (fecal incont­inence)
- Are all visits to the toilet to pass poo the same? Or on some visits its harder? (alter­nating with consti­pation indicate possible irritable bowel syndrome)
- Do you pass large or small volumes of stool?
- Do you have to run to the bathroom to have a bowel movement (fecal incont­inence)
- Have you woken from sleep during the night just so you can visit the washroom to pass stool? (organic cause)
- Has it become better or worse? more or less toilet visits?
- Has this happened before? What did you do to make it better? Have you tried that again? Do you know what caused it then?
- Have you done anything now (new/old) for the diarrhea?

- Are you eating well?
- Are you passing urine well? If dehydrated –pass less urine and dark colored.
- Is this affecting your work or sleep?
- Have you had recent fever, rigors or chills? (e.g., infection, lymphoma)
- Do you have any tummy aches , vomiting, feeling of wanting to vomit, weakness or tiredness?
- How much water have you been drinking since this started? How much water do you normally drink?
Have you lost weight? Partic­ularly in recurrent or persis­ten­t/c­hronic diarrhoea (e.g., cancer, malabs­orp­tion)
- Malabs­orption symptoms: bloating, abdominal pain, flatus

- Do have any problem with your joints, like your fingers or knees?
- Have you ever been told you have any condition such as arthritis, hypert­hyr­oidism, or cancer?
- Have you ever had counce­lling for anxiety or depression {ensure}
- Do you suffer from HIV or malnut­rition

- Are you currently taking any medicine?
Note: anti diarrh­oeal: Imodium, iopermide, gastroso
anti-b­iotics: Clinda­mycin, cephal­osp­orins, ampicilin
Antibi­otics, can cause a Clos­tridium diffic­ile­ en­ter­oco­litis, or pseudo­mem­branous colitis. This can occur up to several weeks after antibiotic therapy.
Laxative: magnesium hydroxide, bisacodyl
Antacids: containing Mg
most drugs have diarrhea as a side effect

- Do you know if anyone else at home or work also have a similar illness? (outbreak)
- Are your parents alive and well? (dwell)
- Do you have ay siblings (dwell)
- Did any of your family members have any problems with their tummy aide from what you are experi­encing? stomach ache, vomiting etc
- Is there any member suffering from any long term diseases
- Has anyone in your family been told that they have a condition like cancer?

- what do you do for work?
- Where do you live?
- What is your water source? Do you always boil the water before you drink? Do you make sure to wash your hands before eating or preparing meals? Do you keep the place where you prepare food clean?
- How do you cook your food? Is it always cooked well?
- How a your toilet facili­ties? What type of toilet do you use?
- Do you smoke cigare­ttes? Does anyone else in the household smoke?
- Do you drink alcohol?
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- Do you remember what you ate before your diarrhea started?
- Did you recently go to any social function and eat/drink anything?
- Did you recently travel to any rural areas or overseas?
- Are you married? Do you have any children?
- DO you have any parnters?
- Do you engage in safe sex, using condoms?

- Establish the PC as infrequent passage of stool (<3X weekly)
- Hard stool

- When did it start? When was the las time you went to pass toilet?
- How many times do you usually pass toilet?
- How many times do you pass toilet now/be­fore?
- Have you taken a look at your stool? have you noticed its hard or soft?
- Do you pass gas/ fart? (if no, may be complete obstru­ction)
- Do you have any pain while passing toilet? (anorectal disease)
- Do you have to really strain your self?
- Is this something thats constantly happening? or is there some days where you have to pass stollomore often, something like diarrhea?
- Do you notice any blood, or anything slimey like mucous?
- Did you take anything to make it better like medicine or drinking lots of water? did it help?

Appetite
Urine output
Sleep: depres­sio­n-not sleeping well
Activity: work, school

Abdominal pain
If there is abdominal pain: is it relieved by passing poo? IBS, intestinal obstru­ction
Tenesmus (sensation of incomp­letee evacuation on defeca­tion)
Abdominal distension
Bloating
Fever
Weight changes : if chronic
Weight loss: colon cancer
Weight gain: hypoth­yro­idism

- Have you had any surgeries for your gut?
- Have you ever been told by a doctor to have a condition such as inflam­matory bowel disease?

- Are you currently taking any medica­tions?
- Are there any home remedies you have tried?
- Do you have any allergies?

- Has anyone in your family ever been told by a doctor to have a condition known as colorectal cancer? or any cancer of the body?
- IBD