Constipation Not Always Easy to Spot.

TORONTO -- Chronic pelvic pain in a teenage girl could be nothing more than chronic constipation.

But physicians may really have to coax details out of these young patients to make the diagnosis, Dr. Cynthia Holland said during the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

"Teenage girls do not like to think about--let alone talk about--their bowel habits, so I really push them with questions about what their stools are like," said Dr. Holland of Ohio State University, Columbus.

She asks patients whether their stools are hard and if they have to push hard to move their bowels or have pain during bowel movements.

Sometimes if you ask enough of the right questions, you can get them to acknowledge that there may be a problem, she said.

Many teenagers are susceptible to constipation because they have poor diets. And girls in particular may also have poor bathroom habits.

"Many girls won't want to have a bowel movement at school or at a friend's house or anywhere in public because they are embarrassed. And so it leads to this vicious cycle where after a while the rectum becomes less sensitive to the pressure and stimuli, and they lose that perception of needing to go," she said in an interview.