Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Laboratory Tests and Diagnostic Investigations for this patient should include:
- Urine dipstick test to detect blood, protein, leukocytes, nitrites, and glucose as initial screening for urinary tract infection or other abnormalities, using an appropriate clean-catch sample (not from leg bags) NICE CG148.
- If infection is suspected, order urine culture and antibiotic sensitivity testing before antibiotic initiation NICE CG148.
- A clinical neurological examination focusing on lumbar and sacral spinal segment function to assess for neurological causes of urinary and bowel symptoms, particularly due to recent sacral shingles affecting sacral nerves NICE CG148.
- Consider viral swabs and PCR testing for herpes simplex virus at the site of oral lesions to confirm HSV infection if clinically indicated NICE CKS,NICE CKS.
- Blood tests to evaluate for immunocompromise including HIV testing, especially given recent shingles and herpes outbreaks which can be indicators of underlying immunosuppression NICE CKS,NICE CKS.
- Neurological imaging (e.g., MRI of the sacral spine and pelvis) may be warranted if the clinical neurological examination suggests possible nerve damage or other causes of neurogenic bladder and bowel dysfunction NICE NG127.
- Assess for other potential causes of neurological symptoms such as Lyme disease with clinical history and serological testing if exposure risk or characteristic symptoms present NICE NG95.
Additional clinical assessments: A focused physical examination including abdominal, external genitalia, vaginal or rectal examination to check pelvic floor status, faecal loading, and anal tone is important to elucidate causes for difficulty defecating and urinating NICE CG148.