42: IRRITABLE BOWEL SYNDROME

PATIENT PRESENTATION

A 28-year-old White woman presents to your office with a chief complaint of constipation and abdominal pain. On further questioning, she reports she has had this problem since beginning college at the age of 18 years. Her symptoms have waxed and waned since this time, but never have worsened. She describes her abdominal pain as dull, crampy, and nonfocal but more prominent in the left lower quadrant, and sometimes relieved with defecation. She denies radiation of pain, nausea, vomiting, fever, chills, weight loss, heartburn, or bloody or dark stool. She reports having a bowel movement every 1 to 2 days that is hard and feels incomplete. She has tried over-the-counter remedies, including stool softeners and antacids, but experienced only minimal improvement in her symptoms. She takes only birth control pills and denies any use of herbs or laxatives. Her family history is negative, including for colorectal cancer and inflammatory bowel disease, and she reports that her parents and siblings are healthy. She is currently engaged and reports significant stress in preparing for the wedding. On physical examination, you note her to be somewhat anxious, but otherwise in no apparent distress. Her vital signs and general physical examinations are normal. Her abdomen has normal bowel sounds, no tenderness on superficial and deep palpation, and no rebound, rigidity, or guarding. Liver and spleen size are within normal limits and no masses are palpable. Pelvic examination is normal. Rectal examination shows normal sphincter tone, no masses, and brown stool that is occult blood negative. ¹