{"id":3693,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/alteredbowelhabit\/"},"modified":"2026-03-19T15:08:41","modified_gmt":"2026-03-19T15:08:41","slug":"alteredbowelhabit","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/alteredbowelhabit\/","title":{"rendered":"Altered Bowel Habit"},"content":{"rendered":"\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-2bdefc3b558aae3197dfe46bc2c86d39\">If you are concerned about Colorectal Cancer in the context of&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/colorectalcancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">Altered Bowel Habit<\/a>&nbsp;please see the Colorectal Cancer page on the pathway to follow.<\/p>\n\n\n\n<p>The most common cause of altered bowel habit in those<strong> under 50 years<\/strong> is <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/irritablebowelsyndromeibs\/\" target=\"_blank\" rel=\"noreferrer noopener\">Irritable Bowel Syndrome (IBS)<\/a>, <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/coeliac\/\" target=\"_blank\" rel=\"noreferrer noopener\">Coeliac<\/a> and <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/inflammatoryboweldisease\/\" target=\"_blank\" rel=\"noreferrer noopener\">Inflammatory Bowel Disease<\/a> should also be considered.<\/p>\n\n\n\n<p>Please see separate Diagnostic &amp; Management pathways.<\/p>\n\n\n\n<p><strong>JB, RC, IA, SD, FD &#8211; March 2026<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>For&nbsp;<strong>Colorectal Cancer Referrals<\/strong>&nbsp;please see guidance&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/colorectalcancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For&nbsp;<strong>Inflammatory Bowel Disease Referrals&nbsp;<\/strong>please see guidance&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/inflammatoryboweldisease\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For&nbsp;<strong>Irritable Bowel Syndrome Referrals&nbsp;<\/strong>please see guidance&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/irritablebowelsyndromeibs\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a><\/li>\n\n\n\n<li>For&nbsp;<strong>Coeliac Disease Referrals&nbsp;<\/strong>please see guidance&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/coeliac\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a><\/li>\n<\/ul>\n\n\n\n<p>For any other referrals to Gastroenterology regarding lower GI symptoms&nbsp;<strong>that do not fit into one of the referral pathways above<\/strong>&nbsp;then referrals can be sent to:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>RIE &gt;&gt; Gastroenterology \u2013 Medical &gt;&gt; GI Lower<\/li>\n\n\n\n<li>SJH &gt;&gt; Gastroenterology \u2013 Medical &gt;&gt; GI Lower<\/li>\n\n\n\n<li>WGH &gt;&gt; Gastroenterology \u2013 Medical &gt;&gt; GI Lower<\/li>\n<\/ul>\n\n\n\n<p>Please note that the only referral priorities for this referral route are Routine or Urgent. There is no option for USC referral.<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-d28eee86e11b6b43dd76c63cf68440f1\"><strong>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 <u><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/colorectalcancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp COLORECTAL CANCER PAGE<\/a><\/u><\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Basic investigations in Primary Care<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>FBC, Ferritin (+\/- Iron and transferrin)<\/li>\n\n\n\n<li>LFTs, TFTs, Ca, Alb<\/li>\n\n\n\n<li>CRP\/ESR<\/li>\n\n\n\n<li>Coeliac screen<\/li>\n\n\n\n<li>Faecal calprotectin (FCP) (<strong>those under 50 years old<\/strong>)*<\/li>\n<\/ul>\n\n\n\n<p>* Please remember that FCP is <strong>not <\/strong>a test for Colorectal Cancer. If you have any concerns re CRC please refer via the appropriate pathway: <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/colorectalcancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">Colorectal Cancer<\/a>. FCP can be a marker for IBD but can also rise in gut infections and with some medications. Please see guidance on the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/inflammatoryboweldisease\/\" target=\"_blank\" rel=\"noreferrer noopener\">IBD<\/a> page for how to interpret a raised FCP.<\/p>\n\n\n\n<p>A 4-week Watch &amp; Wait Policy is reasonable in those with<strong> Low-risk features<\/strong> such as:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Transient symptoms (less than 4 weeks)<\/li>\n\n\n\n<li>Patients <strong>under 40 years<\/strong> in absence of high-risk features<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Watch and wait Policy&nbsp;(4 weeks)<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Assessment and review<\/li>\n\n\n\n<li>Consider bowel diary<\/li>\n\n\n\n<li>Appropriate information, counselling and agreed plan for review with GP<\/li>\n\n\n\n<li>Refer if symptoms persist or recur<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>If you are concerned about Colorectal Cancer in the context of&nbsp;Altered Bowel Habit&nbsp;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 &amp;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3955,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[195],"class_list":["post-3693","page","type-page","status-publish","hentry","category-alteredbowelhabit"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/gastrointestinal\/alteredbowelhabit\/\" rel=\"tag\">Altered Bowel Habit<\/a>","rttpg_excerpt":"If you are concerned about Colorectal Cancer in the context of&nbsp;Altered Bowel Habit&nbsp;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 &amp;","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3693","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3693"}],"version-history":[{"count":12,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3693\/revisions"}],"predecessor-version":[{"id":27308,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3693\/revisions\/27308"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3955"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3693"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3693"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}