CTCAE grading of bowel movement changes:
Grade 1 (Mild): Asymptomatic; clinical or diagnostic observations only; intervention not indicated
Grade 2 (Moderate): Abdominal pain; mucus or blood in stool
Grade 3 (Severe): Severe abdominal pain; change in bowel habits; medical intervention indicated; peritoneal signs
Grade 4 (Life-threatening): Life-threatening consequences; urgent intervention indicated
Characterize the symptom (onset, pace)
Ask the patient:
Do you have any history of GI problems? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Are you taking any medications/OTCs/supplements for your bowel movements? Are you taking marijuana? What else have you done/taken for this symptom?
Suddenly would be more consistent with peritoneal signs.
Grade the symptom
Ask the patient:
How much blood and mucus is in the stool? How have your bowel movements been? What is your normal baseline? How many bowel movements per day do you have now?
Ask the patient:
Do you have any abdominal (belly) pain/tenderness, nausea, fever, or decreased appetite?
Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?
If the bowel movement changes are moderate/severe, the patient should be seen.
If patients have any of the red-flag symptoms, they should be seen for GI workup or referred to the ED.
What do you suspect is the cause of the bowel movement changes?