02-20-2008, 09:11 AM
A 34-year-old woman comes to the clinic for evaluation of chronic constipation. She has one
bowel movement every week and often suffers lower abdominal fullness and distension.
Over-the-counter bowel remedies help somewhat, but she is concerned that something more
serious may be going on. Her constipation has been chronic but has been worse over the last
2 years. Aside from constipation, she reports no other gastrointestinal problems and generally
feels quite healthy. In addition to her current problem, she was diagnosed with gestational
diabetes while pregnant with her fifth child 2 years ago and also suffers occasional urinary
incontinence. Family history is remarkable for a sister with irritable bowel syndrome and an
uncle who died of colon cancer at age 65 years. Physical examination, routine chemistries,
and a complete blood count are within normal limits. Given this patient's presentation, which of
the following is the most likely explanation for this woman's constipation?
A. Abnormal anorectal sphincter tone
B. Autonomic neuropathy
C. Functional or idiopathic constipation
D. Left-sided colonic mass
E. Right-sided colonic mass
bowel movement every week and often suffers lower abdominal fullness and distension.
Over-the-counter bowel remedies help somewhat, but she is concerned that something more
serious may be going on. Her constipation has been chronic but has been worse over the last
2 years. Aside from constipation, she reports no other gastrointestinal problems and generally
feels quite healthy. In addition to her current problem, she was diagnosed with gestational
diabetes while pregnant with her fifth child 2 years ago and also suffers occasional urinary
incontinence. Family history is remarkable for a sister with irritable bowel syndrome and an
uncle who died of colon cancer at age 65 years. Physical examination, routine chemistries,
and a complete blood count are within normal limits. Given this patient's presentation, which of
the following is the most likely explanation for this woman's constipation?
A. Abnormal anorectal sphincter tone
B. Autonomic neuropathy
C. Functional or idiopathic constipation
D. Left-sided colonic mass
E. Right-sided colonic mass