A 72-year-old man presented to his GP complaining of constipation. He reported increasing difficulty opening his bowels for 3 weeks. He was passing small lumps of hard brown stool every 1–2 days. There was no blood or mucus present, and he had no problems with his bowels prior to this. He underwent a medication review 4 weeks earlier and attributed his new symptoms to the prescription changes that were made. He denied experiencing weight loss, back pain or abdominal pain.