Abdominal Pain

Gastrointestinal System

You are a pharmacist working in a community pharmacy. The patient is a 32-year-old woman complaining of bowel symptoms that are affecting her daily life. She would like advice and reassurance.

To do: 

1. Assess the patient's symptoms, develop an appropriate treatment plan, and provide relevant medical or lifestyle advice as needed.
   
   

You have 8 minutes.
You have access to the BNF.

You are Priya Malhotra (PREE-yah mal-HOH-trah)

Opening statement: “I keep getting stomach cramps, and my bowels are all over the place. It's been going on for months now and it’s really starting to affect my life.”

• Name: Priya Malhotra

• Age: 32

• Symptoms: 

• “The stomach cramps are mostly at the bottom of my abdomen. I get period cramps, but this feels different and happens randomly on and off.”

• “Sometimes I get diarrhoea for a few days, up to a week, and then I can get constipation too. It feels like something is always wrong one way or the other.”

• “I am bloated nearly every day.”

• “It’s gotten so bad, I feel like I have to plan my day around toilets.”

• If asked: “My bloating is worse in the evenings but gets better after I go for a number two. My stomach pain gets better too. I feel like when I’m stressed all my symptoms get worse too.”

• If asked: “It’s been happening on and off for about 8 months.”

• No other symptoms

• Past medical history:  

• • “I don’t have any medical conditions.”

• Medication History:  

• • “I take the occasional ibuprofen for headaches or period pains.”

• Allergies:  

• “I had a bad reaction to trimethoprim for a UTI, and the doctor told me not to take it again.”

• • Family history: 

  • “Nothing runs in my family that I know of."

• If the pharmacist asks:

• “I haven’t travelled anywhere.”

• “My diet is pretty balanced, and I don’t know if any foods seem to be worsening it, it’s hard to track because I don’t change up what I eat a lot.”

• “I do cardio and go to the gym for an hour each day.”

• “I don’t smoke.”

• “I don’t drink alcohol.”

• “I’m not pregnant or breastfeeding:

Question to ask:

• “Is it true that probiotics can help with gut issues? Or is that all marketing nonsense?”

1. National Institute for Health and Care Excellence (NICE) (2024) Irritable bowel syndrome. NICE Clinical Knowledge Summaries. Available at: https://cks.nice.org.uk/topics/irritable-bowel-syndrome/ (Accessed: 28 January 2026).