Functional Bowel Assessment - Information Sheet

What is Functional Bowel Assessment?

Functional Bowel Assessment is a diagnostic test used to assess bowel function. The testing comprises the manometry assessment as well as physiology assessment of muscle and nerve function. It measures the pressure and coordination of the muscles in these areas, helping to evaluate issues related to bowel movements, such as constipation, bloating, incomplete emptying, diarrhoea, urgency, faecal incontinence, and pelvic floor disorders.

How Does It Work?

During the Test:

You will be positioned comfortably, typically lying on your side.
A digital rectal examination will be performed by a health practitioner.
A thin, flexible tube called a manometry catheter is gently inserted into your rectum.
The catheter has sensors that measure the pressure in bowel.
You may be asked to perform tasks like squeezing your anal muscles or simulating a bowel movement while the pressures are recorded.
Bowel reflexes will be tested.
Bowel sensation is measured.
Nerve conduction tests will also be conducted.
Electromyography will be conducted to determine the activity of the pelvic floor muscles.

Duration:

The entire procedure usually lasts about 10 minutes.

Why is Functional Bowel Assessment Important?

Functional Bowel Assessment helps bowel diagnostic and therapy practitioners:

Diagnose conditions affecting bowel function.
Create targeted treatment plans to address specific issues, ultimately improving your quality of life.

Addressing Common Patient Concerns

Is the test painful?: Most patients report minimal discomfort during the test. You might feel some pressure or cramping, but this is typically brief.
Is there any preparation required?: No special preparation is needed for this test. You can eat and drink normally before the procedure.
What about privacy?: The test is performed in a private setting by trained professionals who prioritise your comfort and confidentiality.
Will I be able to return to normal activities afterwards?: Yes, you can resume your normal activities immediately after the test. If you notice any unusual symptoms, contact your bowel diagnostic and therapy practitioner.
What happens after the test?: Your bowel diagnostic and therapy practitioner will discuss the results with you and recommend any further steps or treatments based on the findings.

Conclusion

Functional Bowel Assessment is a valuable tool for assessing bowel health. If you have any questions or concerns about the procedure, please reach out to your bowel diagnostic and therapy practitioner. Your comfort and understanding are essential for a positive experience.

By ticking this box you acknowledge and understand that, the Functional Bowel Assessment forms an integral part of your initial appointment. *

New Patient Form

It is essential that your health record contains complete and accurate information to provide quality care. Please assist us by filling out this new patient record form. Your personal health information is kept private and secure as required by federal and state privacy.

PERSONAL DETAILS

Title: *

Given Name(s): *

Surname: *

Date of Birth: *

Birth Sex: *

MaleFemale

Gender Identification

Adress: *

Street address *Street address line 2

City *

State *

Postcode *

Distance Travelled to this Appointment: *

Mobile/ Phone Number: *

Email Address: *

Occupation:

HEALTH COVER:

Medicare Number *

Medicare Reference Number (number next to your name): *

Name on Medicare Card *

Medicare Card Expiry Date:

Concession Card CRN:

Concession Card Type:

Concession Card Expiry:

DVA Number:

DVA Card Type:

DVA Conditions:

Private Health Fund:

Private Health Number:

Private Health Cover:

GENERAL PRACTITIONER

General Practitioner First Name *

General Practitioner Last Name *

Practice/ Clinic Name *

Practice/ Clinic Location *

By ticking this box you acknowledge and understand that any referral(s) outside the scope of the Bowel Diganotic and Therapy Clinic must be obtained by your GP.

Any investigations and/ or referrals that are within the scope of Bowel Diagnostics and Therapy will be ordered. *

NEXT OF KIN

Full Name: *

Mobile Number: *

Relationship: *

BACKGROUND

Knowing your cultural background helps us provide health care that meets your individual needs.

Do you Identify as Aboriginal or Torres Strait Islander? *

Is yes, have you registered for closing the gap this year?

YesNo

Have you had a chronic illness for 6 months or longer? *

YesNo

Details of Chronic illness:

You may be eligible for discounted or bulk billed health services. Ask your GP or reception about booking a Care Plan today.

PATIENT ACKNOWLEDGEMENT(S)

I understand that Bowel Diagnostics and Therapy will make up to three attempts to contact me regarding the review of my results. These attempts may be made via SMS, phone call, email, or letter. If these efforts are unsuccessful, or if I fail to attend my scheduled appointments, my results will be sent to my nominated General Practitioner (GP) for follow-up, provided consent has been given. *

I acknowledge that if I do not provide the details of a General Practitioner, or if I do not have one, I accept full responsibility for any missed correspondence or results that would otherwise be forwarded to and reviewed by a GP. *

CONSENT

Do you give consent for our team to discuss your results with a designated person in the case of an emergency/ or in the event your unable to talk? *

No - I do not give consent for anyone to discuss my results with anyone except myselfYes - listed next of kin onlyYes - listed emergency contact onlyYes - listed next of kin and/ or emergency contactYes - other, person to be listed below

Full name, DOB and number of the person you wish to give consent to:

Montier Health collects information for the primary purpose of providing quality health care. *

I consent for correspondence being sent to third parties (GP, etc)I consent for correspondence being sent to My Health Record I consent to be contacted by SMS, email and phoneI consent for my information to be collected and stored by Montier Health and all companies listed under Montier Health (Bowel Diagnostics and Therapy)If being seen by Bowel Diagnostics and Therapy, you consent to your initial consultation and investigations to be direct billed to Medicare

Date: *

Full Name *

Patients Signature *

Draw signature|Type signatureClear

Other - please specify

Word of Mouth Referral - Please list who referred you**Please list the referrers full name**

Medical History

Medication List ***Please list all medications and vitamin supplements and reason for taking**

Do you have allergies/ allergic to anything? *

If yes, please list below:

Have you had any allergy/ intolerance testing done? *

If yes, when and where was the testing conducted?

Please list any previous surgeries and the year of the surgery. *If you have not had any, please write N/A

Smoking/ Vaping Status *

Alcohol Consumption: *

Quality of Life Questionnaire

(Pre-Appointment)

This survey is to better understand your current situation and symptoms. This information will allow us to provide treatments and services to assist with your overall care. Your answers will remain confidential and your personal health information is kept private and secure as per federal and state privacy legislation.

Please use the following key to answer the questions:

1= Never

2 = Rarely

3 = Sometimes

4 = Often

5 = Always

First Name *

Last Name *

Please enter your Date of Birth *

1. Been unable to go to social events because of the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

2. Been unable to do jobs around the home because of the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

3. Found it difficult to stand because of the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

4. Found it difficult to sit because of the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

5. Found it difficult to walk because of the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

6. Found it difficult to exercise or do the leisure activities you would like to do because of the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

7. Lost your appetite and/or been unable to eat because of the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

8. Been unable to sleep properly because of the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

9. Had to go to bed/lie down because of the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

10. Been unable to do the things you want to do because of the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

11. Felt unable to cope with the pain? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

12. Generally felt unwell? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

13. Felt frustrated because your symptoms are not getting better? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

14. Felt frustrated because you are not able to control your symptoms? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

15. Felt unable to forget your symptoms? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

16. Felt as though your symptoms are ruling your life? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

17. Felt your symptoms are taking away your life? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

18. Felt depressed? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

19. Felt weepy/tearful? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

20. Felt miserable? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

21. Had mood swings? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

22. Felt bad tempered or short tempered? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

23. Felt violent or aggressive? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

24. Felt unable to tell people how you feel? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

25. Felt others do not understand what you are going through? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

26. Felt as though others think you are moaning? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

27. Felt alone? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

28. Felt frustrated as you cannot always wear the clothes you would choose? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

29. Felt your appearance has been affected? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always

30. Lacked confidence? *1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Always