Question: A 75-year-old woman presented for evaluation of altered bowel habits and a sensation of pelvic fullness. Over the past several years, she described symptoms of alternating diarrhea and constipation characterized by several days of hard stools associated with straining and a sense of incomplete evacuation followed by the passage of multiple loose, watery bowel movements. Intermittently, the patient also endorsed the passage of scant bright red blood and mucus from the rectum. The patient denied any temporal relationship between her symptoms and type or timing of food consumption, recent dietary or medication changes, nocturnal symptoms, weight loss, nausea, or vomiting.