Altered Bowel Habit

If you are concerned about Colorectal Cancer in the context of Altered Bowel Habit please see the Colorectal Cancer page on the pathway to follow.

The most common cause of altered bowel habit in those under 50 years is Irritable Bowel Syndrome (IBS), Coeliac and Inflammatory Bowel Disease should also be considered.

Please see separate Diagnostic & Management pathways.

JB, RC, IA, SD, FD – March 2026

For Colorectal Cancer Referrals please see guidance here

For Inflammatory Bowel Disease Referrals please see guidance here

For Irritable Bowel Syndrome Referrals please see guidance here
For Coeliac Disease Referrals please see guidance here

For any other referrals to Gastroenterology regarding lower GI symptoms that do not fit into one of the referral pathways above then referrals can be sent to:

RIE >> Gastroenterology – Medical >> GI Lower
SJH >> Gastroenterology – Medical >> GI Lower
WGH >> Gastroenterology – Medical >> GI Lower

Please note that the only referral priorities for this referral route are Routine or Urgent. There is no option for USC referral.

PLEASE DO NOT SEND ANY URGENT SUSPICION OF CANCER REFERRALS VIA THE ABOVE ROUTE. ANY REFERRAL FOR LOWER GI SYMPTOMS WHERE THERE IS A QUERY OF CANCER SHOULD BE SENT TO THE COLORECTAL TEAMS AS PER THE GUIDANCE ON THE RefHelp COLORECTAL CANCER PAGE

Basic investigations in Primary Care

FBC, Ferritin (+/- Iron and transferrin)
LFTs, TFTs, Ca, Alb
CRP/ESR
Coeliac screen
Faecal calprotectin (FCP) (those under 50 years old)*

* Please remember that FCP is not a test for Colorectal Cancer. If you have any concerns re CRC please refer via the appropriate pathway: Colorectal Cancer. FCP can be a marker for IBD but can also rise in gut infections and with some medications. Please see guidance on the IBD page for how to interpret a raised FCP.

A 4-week Watch & Wait Policy is reasonable in those with Low-risk features such as: