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The first step in assessing new onset diarrhea, especially in a patient who uses dietary fiber, is to perform a digital rectal exam to rule out impaction. This approach is critical because dietary fiber intake can sometimes lead to altered bowel habits, and impaction can occur despite a regular fiber intake. The digital rectal exam allows the healthcare provider to assess the presence of fecal matter in the rectum, which can be a direct cause of diarrhea symptoms or irregular bowel movements.

By evaluating for impaction first, the clinician can identify if the diarrhea might be a result of an obstruction rather than an isolated gastrointestinal issue. This can significantly influence the management approach, as treating diarrhea without addressing an underlying fecal impaction could lead to complications or ineffective treatment.

While encouraging increased fluid intake can be helpful in managing diarrhea, especially to prevent dehydration, it does not address the potential underlying issues that may be causing the diarrhea. Similarly, prescribing anti-diarrheal medication without first investigating the cause could mask symptoms or worsen an existing condition, making it less appropriate as an initial step. A full abdominal examination is also valuable, but determining the state of the rectum is more directly related to the immediate evaluation of new onset diarrhea in this context.