Case Study: Chronic Cyclical Constipation and Bloating in a 23-Year-Old Female

Case at a Glance

A 23-year-old female with a low-normal BMI presents with a long-standing, predictable weekly cycle of constipation, characterized by a single day of multiple bowel movements followed by six days of no evacuation, leading to severe abdominal bloating and discomfort.

Patient's Story

The patient, a 23-year-old female, reports a distressing and consistent gastrointestinal pattern. She consumes a normal diet throughout the week but does not have a bowel movement from Monday to Saturday. During this period, she experiences progressive and significant abdominal distension, describing her stomach as stretching to 'double its size.' This is accompanied by feelings of heaviness, bloating, and general physical discomfort. The cycle culminates every Sunday, on which she has 3-4 bowel movements in a single day, completely evacuating her bowels. Following this, her abdominal distension resolves, her stomach becomes 'nearly flat,' and she feels significantly lighter and more comfortable. This exact cycle repeats every week.

Initial Assessment

The patient is a 23-year-old female weighing 50kg, with a calculated BMI of 18.6. Her chief complaint is severe, cyclical constipation with a bowel frequency of once per week. Her diet is primarily pescatarian, including high-fiber foods such as beans, vegetables, and rice, but she also reports consuming 'junk foods' and alcohol on weekends. The patient's primary concern is whether this pattern is a physiological norm for her body or if there are interventions to establish more frequent, regular bowel habits.

The Diagnostic Journey

The patient's presentation warrants a systematic evaluation to differentiate between functional constipation and an underlying organic cause. The initial workup would involve a detailed dietary and fluid intake history, focusing on consistency throughout the week, and a physical examination of the abdomen. Based on the provided commentary, initial management would focus on conservative measures. However, the chronicity and severity of her symptoms, particularly the significant bloating, suggest that further investigation may be necessary. A referral to a gastroenterologist would be appropriate to rule out motility disorders or conditions such as Irritable Bowel Syndrome with Constipation (IBS-C). The cyclical nature of her symptoms, coinciding with weekend dietary changes, is a key area for investigation.

Final Diagnosis

Given the information, a provisional diagnosis of Chronic Idiopathic Constipation (CIC) is made. A primary differential diagnosis is Irritable Bowel Syndrome with Constipation (IBS-C), due to the prominent symptoms of bloating and discomfort that are relieved by defecation. Further evaluation would be required to confirm the diagnosis and rule out other less common motility disorders.

Treatment Plan

A multi-tiered treatment approach was recommended:

1. Lifestyle and Dietary Modification: The first step involves increasing daily fluid intake consistently throughout the week. While her diet contains fiber, ensuring adequate soluble fiber and consistent intake is crucial. She was advised to moderate weekend consumption of alcohol and processed foods, which can negatively impact gut motility.
2. Over-the-Counter Aids: If lifestyle changes are insufficient, a trial of a gentle osmotic laxative (e.g., polyethylene glycol) was suggested to help soften stool and promote more regular movements, rather than waiting for the weekly 'purge.' Stool softeners could also be considered.
3. Specialist Consultation: Given the impact on her quality of life, a referral to a gastroenterologist for a comprehensive evaluation was strongly recommended. This would allow for a definitive diagnosis and access to prescription therapies if needed.

Outcome and Follow-up

The patient was advised to begin a symptom and bowel diary to track frequency, stool consistency, bloating levels, and dietary intake. A follow-up was scheduled in 4-6 weeks to evaluate the effectiveness of the initial lifestyle modifications and any OTC interventions. The primary goal of management is to regulate her bowel movements to a more normal frequency (defined as at least three times per week) and to eliminate the weekly cycle of severe bloating and discomfort, thereby improving her overall well-being.