Abdominal pain

    Any kind of pain in your gut


    Burning/ discomfort behind the breastbone

    Acid reflux

    Taste of sour fluid in your mouth


    Feeling sick

    Loud noises/ gurgling in your abdomen

    Abdominal bloating

    Feeling of swelling in the abdomen other than after a large meal

    Abdominal distension

    Belly sticking out/ “looking pregnant”


    Bringing up gas through your mouth

    Excess flatulence

    Releasing gas more than 20 times a day


    Infrequent, hard to pass and dry faeces


    Very frequent, watery or mushy faeces


    Needing to rush to the toilet

    Incomplete emptying

    Feeling like you are not able to pass all faeces


    Despite regularly getting 7 to 9 hours of sleep


    Referring to the Bristol Stool Chart, please describe the types of stools that you tend to have and the frequency of each type.

    Bowel patterns

    Please describe the time of day that you usually open your bowels and whether you have any associated symptoms, e.g. pain/ discomfort, straining etc.

    Stool size

    Small (less than 1 egg), medium (1-2 eggs) large (more than 2 eggs)

    Thank you for your time.

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