A 21-year-old comes with her mother to your clinic. She tells you she has been suffering from lower abdominal pain on and off for the last year and that it is gradually worsening. This is associated with loose, sometimes offensive-smelling bowel motions. She opens her bowels up to three times per day with morning urgency but never gets up at night to pass stool. Her menstrual cycle has always been problematic, with no fixed pattern and no new changes.
She has no urinary symptoms. Medical history: She denies any previous medical problems and remembers taking citalopram prescribed a few years ago by her GP for low mood. She takes ibuprofen for headaches only. Since being at university, she has been very stressed; she is a mechanical engineering student and finds it challenging to balance her studies, family commitments, and financial problems. Social and family history: She smokes five…
