Differential Diagnosis for 77-year-old Female with Difficulty Having a BM
- Single most likely diagnosis:
- Fecal impaction: Given the patient's history of pessary use and complaint of difficulty having a bowel movement (BM) with stool shaped in pieces, fecal impaction is a likely cause. Pessary use can sometimes lead to constipation or impaction due to pressure on the rectum or vagina.
- Other Likely diagnoses:
- Constipation: This is a common issue in elderly patients and can be exacerbated by pessary use, medications, or decreased mobility.
- Rectal prolapse: The patient's symptoms and history of pessary use could also suggest a rectal prolapse, where the rectal mucosa protrudes from the anus, potentially causing difficulty with bowel movements.
- Hemorrhoids: Although not directly related to pessary use, hemorrhoids could cause discomfort and changes in stool shape due to straining during bowel movements.
- Do Not Miss diagnoses:
- Colorectal cancer: Although less likely, it's crucial to consider colorectal cancer, especially in an elderly patient with a change in bowel habits. The shaped stool could be indicative of a partial obstruction.
- Rectovaginal fistula: This condition, which could be related to pessary use or other factors, would require prompt diagnosis and treatment to prevent further complications.
- Rare diagnoses:
- Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially causing bowel obstruction. It's rare in adults but could present with changes in stool shape and difficulty having a BM.
- Rectal stricture: This could be due to various causes, including chronic inflammation or previous surgeries, leading to narrowing of the rectum and difficulty passing stool.