From rectal bleeding to a change in bowel habit, GPs encounter the whole range of lower gastrointestinal symptoms, sometimes in the same patient. This chapter gives an overview of the more common conditions GPs have to consider, particularly those that can present with rather vague, intermittent or long-standing symptoms and pose a diagnostic challenge. (For more acute problems, see also Chapters 29–31, 43 and 46.)

History

Using open questions at the start of the consultation is the most efficient way to gather important clinical information. Patients are often understandably uncomfortable talking about lower gastrointestinal complaints (many avoid coming to the doctor at all), and may be anxious about any impending examinations you may need to do. So your empathic listening skills are especially important here.

More specific, closed questions should cover the symptom areas outlined in Table 45, in particular red flag features to exclude serious pathology such as malignancy:

Weight loss (clarify how much, and whether intentional or not)