Constipation and Fluctuating Bowel Habits (Inc Suspected IBS)
The Department will periodically contact patients waiting for an outpatient clinic appointment via SMS, with a link to an electronic form. This is part of routine waitlist auditing to ensure patient details are up to date. If you receive this SMS, please update your details.
Availability
North 
South North West Statewide 
This condition is treated in the Gastroenterology clinic
Pre-referral work-up
History
All referrals should comply to 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 Tasmanian Health Pathways website.
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 ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:
- temperature at presentation of > 37.8°C,
- pulse rate at presentation of > 90 bpm,
- haemoglobin at presentation of < 105 gm/l, CRP >30mg/dl at presentation (or ESR > 30 mm/hr)
Urgent / category 1
New onset constipation in patients > 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 ≥5% of body weight in previous 6 months
- Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
Semi-urgent / category 2
Refractory symptoms not responding to medical management without concerning features (as above) and affecting activities of daily living.
Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.
GESA Guideline: Irritable Bowel Syndrome (2006)
Proceed to Emergency Department (ED).
LGH ED Reception – Phone: (03) 6777 6405 Fax: (03) 6777 5201
MCH ED* – Phone: (03) 6478 5120 Fax: (03) 6441 5923
NWRH ED* – Phone: (03) 6493 6351 Fax: (03) 6464 1926
RHH ED Reception – Phone: (03) 6166 6100 Fax: (03) 6173 0489
Advice for medical practitioners can be given by the Medical Officer In Charge (MOIC) - see HealthPathways Tasmania for contact information.
*MCH and NWRH MOICs request GPs call them prior to referring a patient to ensure the patient is being sent appropriately to a safe destination.
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.
We will endeavour to see these patients within 12 weeks
Next available appointment
