External inspection of your bottom and palpation in your rectum by your doctor with a lubricated gloved finger, looking for haemorrhoids, fissures, skin tags, blood or discharge.

A stool sample is collected and sent to the laboratory for culture to detect infection which can be caused by parasites, viruses or bacteria.

This test is used to rule out the presence of certain bacteria, for example, Clostridium difficile (in diarrhoea associated with recent antibiotic use) or Helicobacter pylori (associated with stomach ulcers).

Tests can include a full blood count and a multi biochemical analysis to assess whether you are anaemic, possibly caused by bleeding from the bowel, and give you clues about your overall health such as blood sugar level, and kidney and liver function.

Blood tests can show whether you have an infection or inflammation somewhere in your body. Your doctor may also test your blood for a chemical sometimes produced by colon cancers, called carcinoembryonic antigen or CEA.

This test uses sound waves to capture the internal organs in your abdomen and pelvis: intestines, liver, gallbladder, bile ducts, pancreas, spleen, kidneys and urinary bladder. An ultrasound can be used to show gallstones or sludge in the gallbladder as well as cysts or abnormal growths in the liver, spleen or pancreas.

There are three main imaging techniques:

1. X-rays
2. Computed tomography (CT) scan which takes multiple X-ray images from different angles
3. Magnetic resonance imaging (MRI) scan uses a large magnet and radio waves to create a detailed image on a computer.

Imaging techniques can help detect problems of the stomach, small bowel, colon as well as other internal organs involved in breaking down your food, such as the liver, gallbladder and pancreas. For example, a plain abdominal X-ray may be ordered to look at whether your bowels are full of stools, causing impaction, or if there is an obstruction or blockage. A CT or MRI scan of the abdomen and pelvis may be used as a way to find growths or lumps in organs such as your stomach, bowels and pancreas.

This simple, non-invasive test done after a short period of fasting is used to diagnose small intestine bacterial overgrowth and problems with the digestion or malabsorption of sugars, such as lactose, sucrose, fructose, and sorbitol.

A faecal occult blood test (FOBT) is a test to screen for bowel cancer or polyps, tiny growths on the bowel that can turn into cancer.

A FOBT involves collecting a small sample of faeces and testing it for tiny amounts of hidden, also called occult, blood in your stool.

Australian National guidelines recommendations:

• People aged 50-74 year at average risk and without any symptoms: complete a FOBT every two years.
• People aged 40-49 years at moderate to high risk: complete a FOBT every two years and then a colonoscopy every 5 years from 50 to 74 years of age.

People with a spinal cord injury are no more likely than anyone else in the community to develop bowel cancer. However, lack of sensation may hide symptoms from early detection while chronic rectal bleeding, either due to haemorrhoids or regular digital stimulation/manual extraction, may lead to a false positive (wrong) FOBT result.

Screening is therefore even more important. FOBT is feasible for people with a spinal cord injury to complete but a full examination of the large bowel by colonoscopy may be necessary.

A long, flexible tube is passed through your throat and oesophagus, the canal carrying food from your mouth to your stomach, down into your stomach and the first part of the small intestine, called the duodenum. This test can be used to identify inflammation of your oesophagus, called oesophagitis, which is the result of acid reflux from your stomach or ulcers in your stomach or duodenum.

This instrument allows your doctor to view any abnormalities and remove tissue samples, called a biopsy.

This is a procedure used to visually examine your lower digestive tract for screening and diagnostic reasons. A thin, flexible fibre optic tube, which transmits light and is equipped with a tiny camera, called an endoscope, is passed through the anus and manoeuvred through the large bowel and the last part of the small bowel. This instrument allows your doctor to view any abnormalities and remove tissue samples, called a biopsy.

Note: The recommended frequency of a colonoscopy for screening purposes will vary based on findings and level of risk. Level of risk depends on your family history and is related to the number of first-degree and second-degree relatives with colorectal cancer as well as their age at diagnosis (less than 55 years vs older).

Bowel preparation for colonoscopy

Adequate bowel preparation is important for not missing polyps or possible cancerous lesions. A modified bowel cleansing regime with a longer preparation time is recommended in people with a spinal cord injury to allow for slower colonic movements to pass faecal matter through the intestines. Admission to hospital prior to the procedure is often needed, particularly for people who are more dependent and need assistance with frequent toilet transfers, skin care or monitoring for autonomic dysreflexia. A colonoscopy may be arranged during an unrelated admission.

You should be on a low residue/low-fibre diet and clear fluids earlier than normal to achieve adequate cleansing for a colonoscopy. Solutions, such as Picoprep, have been shown to be safe, effective and better tolerated than polyethylene glycol electrolyte lavage solutions, such as ColonLYTELY. The latter is possibly the safest option but is often poorly tolerated by people with a spinal cord injury due to the large volume (2-4 litres) required to be consumed. Split dosing of this medication has been shown to improve tolerance and effectiveness.