Abdominal Pain and Bowel Irregularities in a Young Woman on GLP-1 Agonist Therapy

Case at a Glance

A 35-year-old woman with PCOS presented with intermittent lower abdominal pain and altered bowel habits while on tirzepatide therapy, raising concerns about potential bowel obstruction versus medication-related gastrointestinal effects.

Patient's Story

The patient, a 35-year-old Caucasian female (BMI 32.6), presented with several hours of intermittent lower abdominal cramping pain occurring multiple times per hour, accompanied by diaphoresis. She described the pain as similar to severe constipation episodes from her past, causing her to double over but not excruciating. Despite the sensation of incomplete evacuation, she was able to pass small amounts of loose stool. The patient had been experiencing regular bowel movements following dietary modifications (dairy elimination) until recently. One week prior, she experienced severe constipation requiring manual disimpaction and suppository use, which she described as one of the worst episodes of her life. Current medications include metformin and spironolactone for PCOS, tirzepatide 12.5mg for weight management, and vilazodone for anxiety. She had recently completed a course of Dukoral vaccine for travel preparation. The patient consumes alcohol occasionally and uses cannabis recreationally on a weekly basis.

Initial Assessment

Physical examination revealed a young woman in mild distress with intermittent abdominal discomfort. Vital signs showed mild diaphoresis but were otherwise stable. The patient appeared well-hydrated and was able to ambulate without difficulty. She had initiated self-treatment with electrolyte solutions, polyethylene glycol, and peppermint oil capsules for presumed IBS-like symptoms.

The Diagnostic Journey

Given the patient's recent severe constipation episode, current use of tirzepatide (known to cause gastrointestinal side effects), and presenting symptoms, differential diagnosis included medication-induced bowel dysfunction, partial bowel obstruction, or functional gastrointestinal disorder. The timing of symptoms following recent severe constipation and concurrent use of GLP-1 receptor agonist therapy suggested a medication-related etiology. Clinical consultation indicated that without prior history of bowel obstruction or abdominal surgeries, mechanical obstruction was less likely than functional bowel issues related to her current medications.

Final Diagnosis

Medication-induced gastrointestinal dysfunction secondary to tirzepatide therapy, with recent severe constipation episode contributing to ongoing bowel irregularities.

Treatment Plan

Conservative management with increased fluid intake, electrolyte replacement, and daily polyethylene glycol supplementation. Patient advised to continue magnesium supplementation and monitor bowel patterns closely. Peppermint oil capsules were recommended for symptomatic relief of cramping. Patient counseled on recognition of red flag symptoms that would warrant immediate medical evaluation.

Outcome and Follow-up

Patient was advised to seek immediate medical attention if symptoms worsened, if she developed complete inability to pass stool or gas, persistent vomiting, or severe abdominal distension. Follow-up with primary care physician was recommended to reassess tirzepatide therapy and consider dose adjustment if gastrointestinal side effects persisted. Patient education provided regarding common GLP-1 agonist side effects and management strategies.