🩺 Symptom Guide

Constipation

Infrequent, difficult, painful, or incomplete passage of stool; may be acute, chronic, functional, secondary, drug-induced, or obstructive

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Red flags

Urgent escalation if any of the following are present: absolute constipation (no stool and no flatus), progressive abdominal distension, persistent vomiting or feculent vomiting, severe or colicky abdominal pain, peritonism, fever or sepsis, dehydration, tachycardia/hypotension, rectal bleeding or melaena, iron-deficiency anaemia, unexplained weight loss, palpable abdominal or rectal mass, sudden persistent change in bowel habit especially in older adults, overflow diarrhoea with suspected faecal impaction, urinary retention, saddle anaesthesia, progressive lower-limb weakness, severe back pain with neurological symptoms, immunosuppression, known malignancy, or concern for bowel obstruction/perforation/cauda equina.

Assess ABCs if unwell. Clarify onset and duration, baseline bowel pattern, last normal stool, last passage of flatus, stool frequency and form, straining, pain on defecation, incomplete evacuation, anorectal blockage, need for digital manoeuvres, rectal bleeding, mucus, abdominal pain, bloating, distension, nausea, vomiting, appetite change, weight loss, fever, urinary symptoms, back pain, neurological symptoms, pregnancy, mobility, hydration, diet, fibre intake, psychosocial factors, recent surgery/travel, and past colorectal history. Review medication causes carefully: opioids, anticholinergics, tricyclics, antipsychotics, calcium-channel blockers, iron, calcium, aluminium-containing antacids, ondansetron/other 5-HT3 antagonists, antihistamines, diuretics. Examine vitals, hydration, abdomen for distension/scars/hernias/masses/peritonism/bowel sounds, and perform digital rectal examination when appropriate to assess stool loading, impaction, blood, fissure, haemorrhoids, rectal mass, sphincter tone, prolapse, and possible pelvic floor dysfunction. Investigations are selective rather than routine in uncomplicated chronic constipation: consider CBC, U&E/creatinine, calcium, glucose, TSH, CRP if indicated, pregnancy test where relevant
CT abdomen/pelvis if obstruction, perforation, stercoral colitis, ischaemia, or malignancy is suspected.

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Symptom Guide · StatResus — Emergency Medicine Reference