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Assessing bowel dysfunction – taking a history

Watch this video for a demonstration of an example clinical assessment of a man with bowel problems.
Hello, I am Fiona. Thank you for coming today. We are going to have a talk about your bowels, because I understand you have been having some problems with your bowels. Yes. I would just like to go through and just ask you a few questions, just to understand a little bit more about how it’s affecting you. Okay. So, first of all, what sort of problems have you got with your bowel control? The problem is I don’t have much control. And, how long has this been a problem? It is fairly recent. I would say in the last couple of months or so. Yeah.
So, when you say you have not got much control, is it you can’t get to the toilet in time, or? Not always. So, you are having some accidents? You could put it that way, yes. That way, yeah. Can you think of anything that happened in your life about the time that you started having these problems? Not specifically, no, not specifically. Not had any particular illnesses or accidents? No, not particularly, maybe the only thing is I was quite constipated and took some laxative at the time and then, but I stopped since then. And you’ve still got the problem, though you stopped the laxatives? Yes. Yeah. Yeah. And, any particular medical history relating to your bowels? Any surgery on your bowels?
Not that I can think of, no, none at all, none at all. No trauma or injury or anything to that area? No. No, no abdominal surgery or operations? No, no I have no surgery in that region, not at all. And have you had any previous bowel investigations like enemas or any..? No Nobody ever looked at your bowel or investigated your bowel at all? No. The laxatives that you took, how long did you take them for? Several weeks, several weeks. Several weeks. Yes. And it made it worse? It made it better because I was really constipated so, that kind of helped with you know the pain and all this but then its after I stopped that, I started having accidents.
And the laxatives, were they prescribed by your doctor? No. I just went and got something. From the chemist. Yes, that’s right. And just ask a little bit about your food and drink about sort of how many drinks would you say you have in a day? What kind of drinks? Yes, and what type of drinks do you have? Well I drink water, maybe ten cups of coffee a day. Yes. Maybe the occasional glass of wine. So, no change to particularly your fluid intake? No, nothing different, no. And what about your diet, do you eat regular meals? I am mostly vegetarian. Yes. Try to eat healthily I suppose. Yes. And regular meals during the day? Yes, three a day if I can.
And any significant change in your diet? Nope. And if I show you a chart here, can you tell me what sort of motion you think you pass? This is looking at different types. Type one, which is a very hard pebbles, type two which are more formed and lumpy like a sausage, type three which is again a bit more formed, type four which we consider to be sort of more normal, again sausage format, type five looks a bit like chicken nuggets, type six a bit sort of softer and fluffier, going through to seven which is a very watery stool. It would have to be a seven, yeah. So, it is very liquidy, watery. Yeah, you can put it that way, yeah.
Loose stool that you are passing. So, would you say there has been a significant change in your bowel habit with this? Yes, quite suddenly. Yes, quite sudden, yeah. And have you ever seen any blood in your stool? Occasionally. Occasionally. Occasionally yes. Not that I look very often. Do you have any haemorrhoids or piles at all? Never checked. You’ve never checked. Don’t know. No, I can understand that, yeah. That is a sort of slight concern if you are seeing blood in your stool. Well it is not something you are used to seeing. No, absolutely. So, it is something that we perhaps just need to follow up just to get it checked out for you. I would like to, yes.
Yes, is that alright? Of course. And, when you have a bowel action, can you control it at all at the moment or not really? Not really. No, and that’s kind of understandable with it being a loose stool, it is much more difficult for us to control a loose stool so again, that is something we need to follow up and try and understand why you have had that change. Okay. And, can you control your wind, you know your flatus that you lose. No. No and that’s, that’s … Never been the case. Not very nice either is it? No. No, no.
And can you tell, you know when you do need to go, can you tell whether it is going to be liquid or if its going to be wind? Not always. No. Not always this, put it that way, there has been some accidents. And when you get the feeling you need to have your bowels open, how long can you hold for? Have you got to go straight away, or could you hold for a minute or a couple of minutes? Depends but I would say like a minute, a minute and a half, I probably could. Quite a bit of urg … Dance around but not always.
And when you do go to the toilet and you do clean yourself, you do wipe yourself, is it easy to clean or is it sometimes..? No. No. Have you any difficulty opening your bowels when you go to the toilet? No. Its more the other way around. Holding onto, yeah. Can I ask you how you feel about the problems? How is it impacting on your life? It makes life difficult you know, just not being able to go everywhere and with confidence and things get a bit messy. Yes. And, just to refrain from doing a lot of things and it becomes a bit of a logistical nightmare.
With the things that you have talked about, I do think we need to get you referred on to find out because of the concern about the loose stool, the blood in your stool and we need to understand why you are having this problem so that we can get you the right treatment. Okay. So, I do think we need a medical referral. It is unusual to have blood in your stool and that is something that we would want to follow up quite quickly.

Watch clinician Fiona Saunders take ‘Mr Smith’s’ history to assess his bowel dysfunction.

Your task

Make notes on the specific skills the assessor used to:

  1. Put Mr Smith at ease

  2. Identify his symptoms

  3. Identify the effects of his symptoms on his lifestyle

  4. Understand how he feels about his bowel symptoms

Did the assessor and Mr Smith agree any goals?

Was there anything missing from the assessment?

Don’t forget to capture your thinking in your learning log or portfolio.

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Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults

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