Functional disorder with recurrent abdominal pain ≥1 day/week for 3 months, related to defecation and stool change (Rome IV).
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Age >50, weight loss, PR bleed, nocturnal symptoms, anaemia, family CRC
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • CBC, CRP, coeliac serology, faecal calprotectin
- • TSH if diarrhoea
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Reassurance + dietary modification (low FODMAP trial)
- • Probiotics 4 weeks
- • Targeted symptom treatment
Drug therapy
- • Constipation: ispaghula, PEG; linaclotide if refractory
- • Diarrhoea: loperamide
- • Pain: mebeverine 135 mg TDS, peppermint oil; low-dose TCA
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
