Last reviewed: 11 Mar 2021
Last updated: 18 Jan 2021

Summary

Definition

History and exam

Key diagnostic factors

  • intermittent abdominal pain
  • abdominal distention
  • nausea
  • vomiting
  • change in bowel habit
  • risk factors
  • hard faeces
  • soft stools
  • empty rectum
  • recent weight loss
  • rectal bleeding
  • palpable rectal mass
  • palpable abdominal mass
  • tympanic abdomen
  • fever
  • abdominal tenderness
  • abdominal rigidity

Risk factors

  • colorectal adenomas or polyps
  • current or previous malignancy
  • inflammatory bowel disease
  • diverticular disease
  • current or previous hernia
  • gynaecological conditions
  • diabetes
  • previous abdominal surgery
  • previous radiotherapy
  • family history of bowel cancer
  • age
  • male sex
  • obesity
  • megacolon
  • laxative abuse
  • diet
  • alcohol consumption
  • smoking

Diagnostic investigations

1st investigations to order

  • computed tomography
  • full blood count
  • electrolytes
  • C-reactive protein
  • urea/creatinine ratio
  • glucose
  • clotting, group and save, or cross-match
  • arterial blood gas (including lactate)

Investigations to consider

  • beta-human chorionic gonadotrophin
  • urinalysis
  • electrocardiogram
  • water-soluble contrast study
  • lower gastrointestinal endoscopy or flexible sigmoidoscopy

Treatment algorithm

Contributors

Expert advisersVIEW ALL

General and Colorectal Surgeon

Queen’s Medical Centre

Nottingham

UK

Biography

JA is Clinical Lead for General Surgery, Getting It Right First Time.

Disclosures

JA is trustee and council member of the Royal College of Surgeons of England.

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:

George Malietzis, MBBS, MSc, MRCS

Colorectal Registrar

Department of Coloproctology

St Mark's Hospital

London

UK

*

John T. Jenkins, MD

Consultant Colorectal Surgeon

Department of Coloproctology

St. Mark's Hospital

London

UK

Peer reviewersVIEW ALL

Consultant Colorectal and General Surgeon

North Devon Healthcare NHS Trust

Devon UK

Disclosures

CB declares that she has no competing interests.

Section Editor, BMJ Best Practice

Disclosures

EQ declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including NICE, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, NCEPOD, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare, and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services. 

Comorbidities Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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