22nd July 2023

A 61-year-old woman presents to her local emergency department with a 4-week history of loose stools

A 61-year-old woman presents to her local emergency department with a 4-week history of loose stools. She is now opening her bowels at least twice daily, whereas her normal bowel habit is one motion every other day. Her stool is occasionally mixed with mucus but there is no blood. There is associated mild abdominal discomfort, which usually resolves upon opening her bowels. She denies weight loss, PR bleeding, haematemesis, anorexia, nausea, vomiting, fever or dyspepsia. She has never had symptoms like this before. She has a history of generalised anxiety disorder and chronic fatigue syndrome. She takes sertraline 25mg OD and has no medication allergies. Her younger sister has had similar symptoms over 30 years ago which improved with dietary modifications. She has been an accountant for 32 years and describes her job as “high stakes and high pressure”; however, she does not feel that this affects her generally. She is a non-smoker, drinks 1 cup of coffee daily and does not drink alcohol. Her GP requests blood and stool testing and submits a 2-week wait referral on the lower GI pathway.

Which element of her history suggests organic over functional pathology?

Select the SINGLE most appropriate option from the list below. Select ONE option only.