Case history
Case history #1
A 34-year-old mother of three presents to her family physician with a 3-week history of abdominal cramping pain in both lower quadrants. She has been having frequent small, soft stools accompanied by some mucus but no blood. Her symptoms are improved with bowel movement or passage of flatus. She has had these symptoms almost monthly since she was in college, but they have been worse recently. Past history is unremarkable except for three normal pregnancies. Family history is negative for colon cancer. A sister has similar symptoms but has not seen a physician. Personal/social history reveals that she is an accountant working long hours. Her firm is about to merge with another, and she fears her job situation is tenuous. She has not lost any weight or had any other constitutional symptoms. On physical exam, the only finding is some mild tenderness in the right lower quadrant. No mass is felt.
Case history #2
A 40-year-old housewife complains of recurrent constipation. She has had problems since her 20s, but they are worse now. The constipation is accompanied by abdominal bloating and abdominal pain, and the discomfort is only better when she has a bowel movement. On her gynecologist's advice, she has tried more fiber in her diet, including fresh fruits and leafy vegetables, but that has only made the bloating worse. Her past history includes cholecystectomy and hysterectomy. Physical exam is entirely normal. Rectal exam reveals normal consistency stool. Stool samples test negative for occult blood.
Other presentations
Patients can also present with alternating diarrhea and constipation that is associated with abdominal pain.
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