22nd July 2023

A 75-year-old man is seen in a 2-week wait gastroenterology clinic having presented to his GP with a 4-week history of difficulty opening his bowels

A 75-year-old man is seen in a 2-week wait gastroenterology clinic having presented to his GP with a 4-week history of difficulty opening his bowels. His bowel motion frequency has reduced from alternate days to once a week. He strains to defecate and admits that at times has had to use manual evacuation techniques to aid the passage of very hard stool. He denies any abdominal or back pain, weight loss, anorexia, nausea, vomiting, PR bleeding, melaena, fever, fatigue, cold intolerance or focal neurological deficits. He is able to pass flatus. His medical history includes bilateral cataracts, hypertension, severe right hip osteoarthritis and anxiety. His regular medications are ramipril 5mg OD, sertraline 25mg OD, paracetamol 1g QDS and codeine 60mg QDS PRN – in the last 6 weeks he has taken this on a regular basis due to worsening of his hip pain. There is no family history of GI malignancy. He is retired, an ex-smoker with a 10-year pack history and drinks 15 units of alcohol per week. His abdomen is distended but soft and non tender with normal bowel sounds. PR exam reveals hard stool in the rectum but no palpable masses or bleeding with normal anal tone and sensation. Blood tests, including full blood count, renal and liver function and a stool FIT test, are all normal.

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