Middle aged female with Chronic Constipation and Pain abdomen

A female aged 55 years Chief Complaints Chronic Constipation not relieved by Laxatives and High fiber diet Pain Abdomen and Manual evacuation of Hard Stools since 12 days Investigations Xray abdomen

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Age does not support of the loss of muscle tone and sphincteric paralysis until and unless ther is other underlying disease causing paralysis. Pt is having habitual constipation particularly in females with history less water intake Manual removal followed by plain water or soap enema daily to liquify the impacted hard stool.

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Scanty fluid level rt lumbar flank Pt is chr habitual pt of constipation that makes chr gasteroparasis hence needs to be on bulk laxatives R/o rectocele Paralysed anorectal sphincter

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Multiple air fluid levels. ? Subacute intestinal obstruction. Suggest colonoscopy ,CT abdomen , thyroid profile, electrolytes

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Two air fluids level. Usg abd Ct abd if needed

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Kindly do s.tsh

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