30th April 2024

A 65-year-old woman presents with a six-month history of progressively worsening constipation.

A 65-year-old woman presents with a six-month history of progressively worsening constipation. She reports needing to strain significantly during bowel movements and only passes hard stools twice a week. She denies any recent changes in diet or medication. Her medical history is unremarkable. On examination, her abdomen is soft, non-tender, and there are no palpable masses. Her rectal examination is normal. She has tried over-the-counter fibre supplements and increased water intake without improvement.

Which test would be most appropriate to confirm the most likely diagnosis?