[39M] Experiencing constipation, chest pain, and weakness

Patient Description

A 39-year-old male reports a significant change in bowel habits, experiencing constipation for a week with only small, sliver-like bowel movements despite eating two or three meals daily. This is a marked change from his usual pattern of at least one bowel movement per day. The patient also describes mild to moderate chest pain on the right side near the armpit, extending to the shoulder, which began a day or two ago and worsens after eating. The pain is alleviated by laying down. Additionally, the patient has been feeling weak, particularly over the past week, with a noted difficulty in taking long breaths. A week prior, the patient had diarrhea and headaches, which were thought to be symptoms of a stomach flu, as others in the household were also sick. The patient's medical history includes an ER visit 11 months ago for severe upper abdominal pain due to sludge in the bile duct, for which lifestyle improvements were recommended. Both of the patient's parents have had their gallbladders removed, and his mother has Crohn's disease, though he has no personal history of these conditions. The patient is currently using MiraLAX and a CVSHealth Mini Enema to manage constipation without significant relief. No known drug allergies or other medications reported.

Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

Gallstones or Biliary Sludge: Given your history of biliary sludge and the location of your pain, it's possible that you may be experiencing a gallbladder issue such as gallstones. Gallstones can cause pain in the upper right abdomen, particularly after eating, and can sometimes cause constipation.
- Treatment usually involves managing the pain and potentially removing the gallbladder if the stones continue to cause problems.
Irritable Bowel Syndrome (IBS): IBS is a common disorder that affects the large intestine and can cause cramping, abdominal pain, bloating, gas, and changes in bowel habits (diarrhea, constipation, or both).
- Treatment often involves long-term management of diet, lifestyle changes, and stress.
Gastroenteritis: This is an inflammation of the digestive tract, often caused by a virus or bacteria. It can cause diarrhea, vomiting, and abdominal pain. Given that you had diarrhea and headaches a week ago, it's possible that this could have disrupted your normal bowel movements.
- Treatment usually involves rest and rehydration. Antibiotics may be needed if the cause is bacterial.
Chronic Idiopathic Constipation: This is a diagnosis of exclusion, meaning it's considered when other causes have been ruled out. It's characterized by persistent, difficult, infrequent, or seemingly incomplete bowel movements.
- Treatment often involves lifestyle changes, such as increasing physical activity and intake of fiber and fluids. Over-the-counter or prescription medications may also be used.

Please remember I'm an AI and this is not an exhaustive list of possibilities. It's important to consult with a healthcare professional for an accurate diagnosis.

What you can do

Continue to stay hydrated and maintain a diet high in fiber. This can help with constipation.
Try to avoid foods that may trigger gallbladder attacks, such as fatty or fried foods.
Over-the-counter pain relievers may help with your chest pain, but please consult with a healthcare professional before starting any new medication.
Keep a symptom diary. Note when your symptoms occur, what you're doing when they occur, and what foods you've eaten. This can help identify any patterns or triggers, which will be useful information for your doctor.