[Expert Solution]: Chief Complaint “Constipation.” History of…

Chief Complaint “Constipation.” History of Present Illness A 58-year-old woman presents to her PCP complaining of constipation for several months. Constipation has been intermittent and has gotten worse over the past few weeks. She is now having a bowel movement about once every 4 days; her stools are hard and painful, and she has bright red blood on the toilet paper after she wipes. The patient has a history of chronic constipation that started in her 20’s; she typically would only have a bowel movement every three days and had to strain to defecate. She does not feel she is able to completely evacuate her bowels. She denies melena or hematochezia, abdominal pain, bloating or excessive gas, loose stools, or fecal incontinence. She is afraid to take medications and has not tried any over-the-counter treatments for fear of side effects. She has had no changes in her regular medications. She reports a regular diet (lean protein, fruits/vegetables, grains) without changes; she admits to not drinking enough water, about 20 ounces daily; she denies caffeine or alcohol use.