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Case 15 

Case 15
Chapter:
Case 15
Author(s):

Alissa J. Walsh

, Otto C. Buchel

, Jane Collier

, and Simon P.L. Travis

DOI:
10.1093/med/9780199557899.003.15
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date: 22 August 2019

A 50-year-old female schoolteacher presented to the outpatient department with a 12-year history of abdominal pain, straining at stool, a feeling of incomplete evacuation, and needing to return to the toilet several times after defecation. She often used per-vaginal digitation to assist the passage of stool and would spend up to 30 minutes on the toilet at any one time. She had seen a dietitian in the past and was on a high-fibre diet and using cracked linseed supplements, and occasional laxatives. Her bowels were currently opening about once daily, although ‘always with difficulty’. She described daily flatus incontinence, but denied any faecal incontinence. Prior to the onset of these symptoms, her bowels had opened every 1–2 days with no difficulty. She had a 13-year-old son (weighing 3700g [8lb 8oz] at birth), born by vaginal delivery with the aid of forceps. She remembered having a vaginal tear at this time, requiring sutures.

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