Impression: Likely constipation with a history of diverticular disease and codeine use.

Document Findings: Record physical examination results and clinical impression in her medical notes.

Monitor Symptoms: Continue to monitor abdominal symptoms and vital signs, ensuring pain and discomfort are appropriately managed.

Further Investigations: If symptoms persist or worsen, consider:

• Abdominal X-ray to check for bowel obstruction or stool impaction.
• Blood tests (FBC, electrolytes, liver function) for infection or electrolyte imbalances.
• CT scan if there’s concern about diverticulitis or other abdominal issues.

Management Plan:

• Optimise constipation management with bulk-forming laxatives and stool softeners
• Ensure adequate hydration to support bowel function.
• Provide pain relief with caution on using opiates, as they can exacerbate constipation.

Discuss with Senior: Escalate to a senior if symptoms worsen or further interventions are needed.

Patient Education: Explain the likely cause (constipation), discuss diet (increased fibre and hydration) and medication adjustments (stop codeine), and provide reassurance.

Follow-up: Ensure continued monitoring of symptoms and follow-up on any additional investigations or changes in condition.

Click here for the NICE Constipation guidelines