Abdominal Pain

Abstract

Ms. Stewart is an attractive, slender, 30-year-old professional who complains of recurrent bouts of abdominal pain, bloating, and diarrhea occurring over the last 6 years. The abdominal pain improves after bowel movements; however, despite having diarrhea, she always feels like her bowel movements are incomplete. She describes painful, loose, watery stools occurring approximately four to five times a day about twice a week. She has never had bowel accidents at night. She has never noticed blood in her stools, although they sometimes contain mucus. She was previously diagnosed with lactose intolerance because of some bloating episodes after drinking milk. Although she avoids milk and cheese, she eats ice cream without problems. She has no other medical symptoms and her weight is stable. She is currently not using any medications for her digestive symptoms. She has never seen a psychiatrist for depression or anxiety. When her primary care physician asks if she was ever the victim of sexual abuse, her lip begins to quiver and tears fill her eyes, but she won’t provide any specific information. Physical examination shows mild, diffuse belly tenderness with no masses or enlarged organs. Laboratory testing shows a normal blood count and electrolytes and is negative for stool guaiac or stool ova and parasites. A previous sigmoidoscopy revealed only small external hemorrhoids. Ms. Stewart is treated with a low-fat diet and is referred for a psychological evaluation to rule out depression.