122. DPR | History and Physical Exam of the Gastroenterology II

A 62-year-old woman presents with constipation for 8 months, worsening over the last 3 months. She has 1–2 bowel movements per week, strains significantly, passes hard stools, and often feels she has not completely evacuated. She denies abdominal pain. Rectal exam shows normal tone, no masses, and soft stool in the vault. GUIAC test is negative. Which diagnosis best fits her symptoms based only on lecture criteria?

A. Irritable bowel syndrome – constipation type
B. Functional defecation disorder
C. Slow transit constipation
D. Colon cancer
E. Hypothyroidism

B

This scenario is exactly the one discussed in Case 3 (slides 50–62 and transcript). The professor explicitly states:

• Functional defecation disorder = MOST LIKELY
  (slide 61: “Functional defecation disorder – Most likely”)

• IBS requires recurrent abdominal pain ≥1 day/week (slide 59) — she has NO pain.

• A – IBS-C requires abdominal pain (Rome IV)—not present.

• B (Correct) – matches incomplete evacuation, straining, chronic course.

• C – cannot be diagnosed without transit testing; not favored in the case.

• D – no red flags (weight loss, anemia, bleeding).

• E – hypothyroidism is treated and not presenting with new systemic symptoms.

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