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Consultation in practice

Amanda is a customer in her late 20s who asks if you can recommend something for diarrhoea. She says that her symptoms started about 24 hours previously. Amanda isn’t taking any other medicines and hasn’t tried anything to relieve her diarrhoea.

Which of the following would you do at this stage?

Click on one of the options below.

Recommend an anti-diarrhoea product

Incorrect

Asking Amanda some further questions will help you find out if she has any other symptoms and if her diarrhoea is acute or recurrent

Recommend rehydration sachets to Amanda

Incorrect

Asking Amanda some further questions will help you find out if she has any other symptoms and if her diarrhoea is acute or recurrent

Ask Amanda some more questions to find out more about her symptoms

Correct

Asking Amanda some further questions will help you find out if she has any other symptoms and if her diarrhoea is acute or recurrent

 

On further questioning, Amanda says that she has IBS and has been experiencing bouts of diarrhoea every couple of weeks for the last few months. She says that she mostly suffers from diarrhoea but has previously experienced constipation and bloating symptoms. Amanda doesn’t describe any symptoms that might indicate a more serious condition.

Which of the following would you now do?

Click on one of the options below.

Refer Amanda to A&E for urgent assessment

Incorrect

Amanda has described symptoms that could be IBS-related and has not mentioned any symptoms that may indicate a more serious condition that would require referral to A&E

Advise Amanda to restrict her fluid intake

Incorrect

Amanda should stay hydrated, (particularly when experiencing diarrhoea) by drinking plenty of fluids, especially water or other non-caffeinated drinks3

Recommend an effective OTC product that will help to treat the root cause of Amanda’s presenting IBS-type symptom, provide her with self-care advice and advise her to speak with her GP regarding her symptoms if she hasn't already

Correct

Whilst following self-care advice, a product such as FyboCalm Diarrhoea Relief can relieve and help prevent gut symptoms recurring. Amanda's GP could help with her IBS management and be able to monitor her recurring symptoms

Self-care advice20

REDUCING DIARRHOEA
RELIEVING CONSTIPATION
EASING WIND AND BLOATING

REDUCING DIARRHOEA

  • Cut down on high fibre foods such as wholegrain foods (e.g. brown bread, brown rice) nuts and seeds
  • Avoid products containing a sweetener called sorbitol
  • If a customer keeps getting diarrhoea, advise them to drink plenty of water to avoid dehydration.

RELIEVING CONSTIPATION

  • Drink plenty of water to help make poo softer
  • Increase dietary soluble fibre; good foods include oats, pulses, carrots, peeled potatoes and linseeds (whole or ground).

EASING WIND AND BLOATING

  • Eat oats, such as porridge, regularly
  • Avoid foods that are hard to digest such as cabbage, broccoli, cauliflower, brussel sprouts, beans, onions and dried fruit
  • Avoid products containing a sweetener called sorbitol.

When to refer

Refer customers to their GP if you think any tests are necessary to rule out other possible causes of symptoms.

Customers should be advised to speak to their GP or NHS111 if:20
  • Diet changes and over the counter products are not helping ease their symptoms
  • They need to avoid lots of different foods to control their symptoms; they may need to be referred to a dietician or specialist for advice.
Customers should be advised to ask for an urgent appointment if they have:5
  • Lost a lot of weight for no reason
  • Bleeding from their bottom or bloody diarrhoea
  • A hard lump or swelling in their tummy
  • Shortness of breath, noticeable heartbeats (palpitations) and pale skin.
These could be signs of something more serious - further tests may be required to rule out other possible causes.

References

1. Camilleri M, et al (2021.) Am J Physiol Gastrointest Liver Physiol. 303(7):G775-85.

2. https://cks.nice.org.uk/topics/irritable-bowel-syndrome/background-information/causes/

3. NICE Irritable bowel syndrome in adults: diagnosis and management (CG61). Available at: https://www.nice.org.uk/guidance/cg61

4. https://cks.nice.org.uk/topics/irritable-bowel-syndrome/background-information/prevalence/

5. https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/symptoms/

6. Bassotti, G et al (2014). World J Gastroenterol. 20(1):37-44.

7. Camilleri (2021). Clinical and Translational Gastroenterology, 12(1), e00308

8. Hanning et al. (2021). Therapeutic advances in gastroenterology, 14, 1-31.

9. Trifan (2019). United European Gastroenterology Journal. (8):1093-1101

10. Gnessi et al. (2015) BMC Gastroenterology,15:153.

11. de Los Rios et al. (2021) Therapeutic advances in gastroenterology, 14, 1-10.

12. Black, CJ et al (2020.) Functional gastrointestinal disorders: advances in understanding and management. Lancet 396: 1664–74

13. Reckitt Data on file

14. Reckitt Data on file

15. Filippone et al (2022). Journal of clinical medicine, 11(23), 7073.

16. Piqué et al (2018). Int J Mol Sci, 19(3), 673.

17. Sekkal et al (2014) INRA-Toxalim, Toulouse, France

18. Esposito at al. United European Gastroenterology Journal 2021; 9 (Supplement 8)

19. Scuderi et al. (2022) Int J Mol Sci, 18;23(4):2269.

20. https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/diet-lifestyle-and-medicines/

Online sources last accessed November 2023

Adverse event reporting

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for the MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Reckitt Benckiser Healthcare (UK) Ltd on 0333 200 5345.