The site and time of onset of a symptom and the evolvement to current presentation are essential to determine. When did the symptom start and was it a sudden or gradual, constant, or intermittent onset? A thorough description of the character and severity of the symptom is important to present together with information on periodicity and frequency. Furthermore factors that predispose, provoke, or alleviate symptoms should be described. The doctor may define symptoms differently than the patient; therefore, it is important to check that terms such as diarrhea, incontinence, constipation, pain, and discharge are interpreted in the same way by the patient.

Recording of any previous hospital admissions, anorectal diseases, cancer or polyps, abdominal operations, and possible medical treatments including radiotherapy are essential. Past medical history should ascertain whether former abdominal surgical procedures have been performed and should report the outcome of the surgery. General medical conditions and comorbidities such as diabetes and metabolic disorders can cause abdominal symptoms and these should be recorded. If major surgery is considered, patients should be questioned about symptoms of respiratory and cardiac diseases.

Patients with a family history of large bowel cancer among first-degree relatives have a three- to four-time greater risk of developing cancer than in families without a history of cancer. Taking a family history can be used as a tool to identify these individuals and to decide who should be referred for genetic counseling. Furthermore information on inflammatory bowel conditions, hereditary bowel diseases, and other significant genetic conditions should be recorded.

The past obstetric history is relevant for patients with fecal incontinence and other disorders of the pelvic floor. Number of births and reports on tears of the perineum or the anal sphincter are significant.

Drug history is to establish which regular medication the patient is taking including dosage and frequency. A thorough drug history provides an opportunity to review the need for the patient to take medication and to find out whether the patient is actually taking them. It is essential to know whether a patient is taking anticoagulants if a biopsy or surgical treatment is contemplated, and patients on oral contraceptives should be identified. It is important to note that several different drugs may affect gastrointestinal motility and lead to functional gastrointestinal disorders. Any allergy should be recorded.

This section documents factors in the patient’s lifestyle, personal habits, and environment, which may reveal a risk of developing or having an illness. Information to be gathered could include: smoking and alcohol intake. How many cigarettes a day has the patient been smoking and for how many years. Which type of alcohol and how many units a week has the patient been drinking? Activities of daily living, family relationship, and occupation should be explored. Has the patient been exposed to any HIV risk factors?

Systemic enquiry consists of a screen for symptoms in other body systems that are not covered in the present complaint and may be missed. It is essential to be selective and focus on the system relating to the actual problem or to a differential diagnose. The main symptoms that should be covered are cardiovascular, respiratory, and gastrointestinal, which is covered in the present complain, urinary, gynecological, CNS, musculoskeletal, and dermatology.