A dietitian and physiotherapy approach to the management of bowel disorders.

Participants are drawn from standard outpatient waitlist list and randomly assigned into group A, group B or group C. Interventions are personalised according to the condition and lifestyle/ preference of participant. We would expect that participants would have a minimum of 1-2 appointments in the group assigned. We would encourage up to 6 months of appointments. However, the participant can stop when they are happy with the advice given, their symptoms improve or no longer want to attend. We are able to track how many appointments the participants attend through our electronic booking system. Group A – Physiotherapy and Dietitian (intervention group) • Group A will see both a physiotherapist and a dietitian for 6 months. Appointments will be every 3-4 weeks for physio and 4-6 weeks for dietetics, 30 to 60 minutes duration each appointment. • Participants will be given the option to continue after this time if they wish. Group B – Physiotherapy only (standard care) • Group B will see a physiotherapist for 6 months with appointments every 3-4 weeks. • Participants will be given the option to continue after this time if they wish. They will also be able to see a dietitian if requested or needed. Group C – Dietitian only (intervention group) • Group C will see a dietitian for 4-6 weeks for 6 months. • Participants will be given the option to continue after this time if they wish. They will also be able to see a physiotherapist if requested or needed. For all groups, physiotherapy will involve • Assessment of bowel function, bladder function and general health and perform a rectal and/or vaginal examination. Appropriate treatment is recommended, for example toileting techniques &/or pelvic floor muscle training and is expected that participants will complete these at home. • The level of intensity of training is individual. It is based on the assessment by the physiotherapist and the referring condition reason • Adherence to strategies are participant determined. There may be bowel and urinary diaries for participants to do however these are for patients to monitor their own symptoms For all groups, dietetics will involve • The dietitian will develop an individualised food plan that may include changes to the amount and type of fibre (for example for soluble fibre, less FODMAP sources, increase overall fibre intake), fat (aiming for less than 20% of energy consumption), and fluid consumed and how and when food is consumed (for example, eating regularly/ not skipping meals, strategies to avoid swallowing air). • Adherence to strategies are participant determined. There may be bowel and food diaries for participants to do however these are for patients to gain awareness about potential link between bowel symptoms and food intake. Intervention will be given face to face, telehealth or via telephone The Dietitians and Physiotherapists have over 15 years of experience and the physiotherapists have specialised training in pelvic floor/ colorectal issues.