Hi Thanks for posting your query on HCM I have read and understood your concern Severe pain under the rib on the right side may be caused by medical conditions like liver, gallbladder, pancreatic or gastric problems. A keen examination by the Doctor will be very important and an abdominal ultrasound may help reveal cause.Treatment will depend on cause. Slightly tilted uterus does not usually pose any particular problems.Vaginal bleeding should be investigated keenly.However, the results of her gynecological exam may not entirely explain such a symptom.A pelvic ultrasound may help reveal a gynecological problem that may explain symptom.However, her Gynecologist is in the best position to take care of this. Many people do suffer from chronic constipation.It is good cancer related causes of constipation have been eliminated.Other causes may include: -Problems with the nerves around the colon and rectum like Autonomic neuropathy, Multiple sclerosis.... -Difficulty with the muscles involved in elimination like anismus and dyssynergia -Conditions that affect hormones in the body like Diabetes, Overactive parathyroid gland, Underactive thyroid I will suggest she tries the following: *She should increase fiber intake *Exercise most days of the week *Laxatives like Fiber supplements, Stimulants, Osmotic laxatives, Lubricants, Stool softeners, Enemas or suppositories Given the chronic nature of her symptoms, i will also advise she see a Gastrologist for evaluation. Hope this will help.You may write back if more concerns. Wish your friend good health Dr Mbuomboh