Browse categories and answer follow-up questions to refine your symptom profile.
History
HPI overview
Core symptom characterization
Constipation definition
Decreased stool frequency
Difficult stool passage
Obstipation definition
Failure to pass stool
Failure to pass flatus
Time course
Acute
Subacute or chronic
OPQRST
Onset
First day without bowel movement
Last normal bowel movement pattern
Provocation and palliation
Worse with
Oral intake
Opioids
Relief with
Laxatives
Enemas
Quality
Stool consistency pattern
Hard stools
Pellet stools
Pain quality pattern
Crampy
Constant
Region and radiation
Pain location
Diffuse abdominal
Lower abdominal
Radiation pattern
Back
Groin
Severity
Pain severity trend
Stable
Escalating
Functional impact
Unable to tolerate oral intake
Unable to sleep
Timing
Intermittent pattern
Colicky waves
Postprandial worsening
Progressive pattern
Increasing distension
Decreasing flatus
Associated symptoms
Gastrointestinal
Nausea
Vomiting
Abdominal distension
Hematochezia
Melena
Systemic
Fever
Weight loss
Anorexia
Genitourinary
Urinary retention
Dysuria
Neurologic
New leg weakness
Saddle anesthesia
Baseline bowel pattern
Prior baseline
Typical frequency
Typical stool form
Straining baseline
Prior interventions
Home laxatives used
Prior disimpactions
Context and triggers
Recent changes
New medication
Reduced mobility
Reduced intake
Recent procedures
Abdominal or pelvic surgery
Colonoscopy
Prior episodes
Recurrence features
Similar prior episodes
Prior obstruction history
Prior outcomes
Prior admission
Prior surgery
Alarm Features
Immediate escalation triggers
Time critical features
Peritonitis features
Rebound tenderness
Guarding rigidity
Hemodynamic instability
Hypotension
Altered mental status
Severe vomiting
Bilious
Feculent
High risk historical features
Obstruction and ischemia risk
Obstipation
Rapidly progressive distension
Prior abdominal surgery
Known hernia
Malignancy risk
Unintentional weight loss
Change in stool caliber
Iron deficiency anemia history
Spinal cord compression risk
Urinary retention
New lower extremity neurologic symptoms
Vital sign danger patterns
Sepsis pattern
Fever
Tachycardia
Hypotension
Pain out of proportion pattern
Severe pain with minimal tenderness
Rising lactate pattern
High risk exam findings
Abdominal exam red flags
Peritoneal signs
Focal tender mass
Hernia with tenderness
Rectal exam red flags
Gross blood
Suspected rectal mass
High risk populations
Increased complication risk
Older adult
Immunocompromised
Anticoagulated
Pregnancy
Postoperative
Medications
Constipating medications
Medication contributors
Opioids
Anticholinergics
Calcium channel blockers
Tricyclic antidepressants
Antipsychotics
Iron
Calcium supplements
5 HT3 antagonists
Antihistamines
Bowel regimen history
Recent bowel agents
Osmotic laxatives
Stimulant laxatives
Stool softeners
Suppositories
Enemas
Recent changes
Timeline of medication changes
New start within 7 days
Dose increase within 7 days
Missed usual laxatives
Contraindications and interaction traps
Laxative safety flags
Magnesium containing products
Renal impairment concern
Hypermagnesemia risk
Sodium phosphate enemas
Chronic kidney disease concern
Heart failure concern
Diet
Intake pattern
Recent intake
Reduced oral intake
Reduced fiber intake
High dairy pattern
Hydration indicators
Volume status clues
Reduced fluid intake
Diuretic use pattern
Dark urine history
Exposures
Constipation related exposures
Caffeine excess
Alcohol excess
Travel diet change
Review of Systems
Gastrointestinal
GI symptoms
Abdominal pain
Distension
Nausea
Vomiting
Flatus pattern
Rectal bleeding
Constitutional and infection
Systemic symptoms
Fever
Chills
Weight loss
Night sweats
Genitourinary
GU symptoms
Urinary retention
Dysuria
Hematuria
Neurologic
Neuro symptoms
New weakness
Sensory change
Saddle anesthesia
Back pain
Endocrine and metabolic
Metabolic symptoms
Heat or cold intolerance
Polyuria
Polydipsia
Collateral History and Family History
Collateral source
Source and reliability
Family or caregiver report
Facility report
Medication list confirmation
Family history
Heritable and family risks
Colorectal cancer
Inflammatory bowel disease
Celiac disease
Endocrinopathies
Social supports
Discharge reliability
Ability to obtain medications
Ability to hydrate
Ability to return for worsening
Risk Factors
Mechanical obstruction risks
Predisposition to obstruction
Prior abdominal surgery
Known hernia
Known malignancy
Prior volvulus
Functional constipation risks
Predisposition to slowed transit
Low mobility
Dehydration
Low fiber diet
Limited toileting access
Secondary medical risks
Predisposition to secondary causes
Hypothyroidism
Hypercalcemia
Diabetes mellitus
Parkinson disease
Multiple sclerosis
Medication risks
High risk drug exposures
Opioid therapy
Anticholinergic burden
Psychotropic polypharmacy
Special populations
Higher complication risk groups
Older adult frailty
Pregnancy and postpartum
Pediatrics
Spinal cord injury
Differential Diagnosis
Life threatening
Cannot miss
Large bowel obstruction
Progressive distension
Obstipation
Small bowel obstruction
Colicky pain
Bilious vomiting
Volvulus
Rapid distension
Severe pain
Bowel ischemia
Pain out of proportion
Rising lactate
Perforated viscus
Peritonitis
Free air concern
Toxic megacolon
Systemic toxicity
Marked colonic dilation
Stercoral colitis
Severe constipation history
Focal abdominal tenderness
Cauda equina syndrome
Urinary retention
Saddle anesthesia
Abdominal aortic aneurysm
Back or abdominal pain
Hypotension
Common
Frequent etiologies
Functional constipation (K59.00)
Low fiber intake
Reduced activity
Fecal impaction (K56.41)
Rectal fullness
Overflow diarrhea
Opioid induced constipation (K59.03)
Opioid exposure
Poor response to fiber
Constipation due to medication (K59.09)
Anticholinergic exposure
Calcium channel blocker exposure
IBS with constipation (K58.1)
Abdominal pain related to stooling
Chronic fluctuating course
Less common
Secondary and zebras
Colorectal cancer (C18.9)
Weight loss
Anemia concern
Hypothyroidism (E03.9)
Fatigue
Cold intolerance
Hypercalcemia (E83.52)
Polyuria
Confusion
Hirschsprung disease (Q43.1)
Lifelong severe constipation
Delayed meconium history
Spinal cord lesion
New neurologic deficits
Back pain
Past Medical History
Gastrointestinal history
Prior GI conditions
Prior bowel obstruction
Inflammatory bowel disease
Prior diverticulitis
Prior colorectal polyps
Surgeries and procedures
Abdominal and pelvic surgeries
Appendectomy
Hernia repair
Colectomy
Gynecologic surgery
Chronic conditions
Medical contributors
Diabetes mellitus
Hypothyroidism
Chronic kidney disease
Neurologic disease
Baseline function
Baseline status
Ambulation level
Toileting independence
Usual diet pattern
Physical Exam
General and vitals
General assessment
Toxic appearance
Dehydration signs
Pain behavior pattern
Vital sign interpretation
Fever pattern
Tachycardia pattern
Hypotension pattern
Abdominal exam
Abdomen
Distension
Bowel sounds pattern
Tympany
Diffuse tenderness
Focal tenderness
Peritoneal signs
Hernia and groin
Hernia evaluation
Inguinal
Femoral
Ventral
Rectal and perineal
Digital rectal exam
Stool in vault
Hard mass consistent with impaction
Gross blood
Rectal tone
Perineal inspection
Fissure
Hemorrhoids
Neurologic and spine
Neuro screen for compression
Lower extremity strength
Sensation pattern
Saddle sensation
Reflexes pattern
Cardiopulmonary
Volume status and complications
Mucous membranes
Capillary refill pattern
Lung exam for aspiration concern
Lab Studies
Core labs when secondary cause or complication concern
Baseline evaluation
CBC
Leukocytosis pattern for infection or ischemia
Anemia pattern for malignancy or bleeding
Electrolytes
Potassium abnormality
Sodium abnormality
Creatinine
Dehydration pattern
Laxative safety implications
Targeted labs for red flags
Complication evaluation
Lactate
Ischemia concern when elevated
Normal value does not exclude ischemia
CRP
Inflammatory pattern support
Nonspecific limitation
Pregnancy test
Imaging selection implications
Ectopic pregnancy mimic consideration
Secondary cause labs when indicated
Metabolic and endocrine
TSH
Hypothyroidism screen
Not an ED routine test without suggestive features
Calcium
Hypercalcemia screen
Constipation contributor when elevated
Imaging
Scoring Systems
Clinical tools and classification
Bristol stool form scale
Stool form pattern documentation
Response tracking over time
Rome IV constipation criteria
Chronic constipation framework
Not an acute obstruction rule out tool
MRI
MRI indications
Spine MRI
Cauda equina concern
Spinal epidural abscess concern
Pelvic MRI
Suspected pelvic mass with nondiagnostic CT
Local protocol dependent
CT
CT abdomen and pelvis
Indications
Suspected bowel obstruction
Suspected ischemia
Suspected stercoral colitis
Protocol considerations
IV contrast when ischemia concern
Oral contrast usually not required in ED obstruction evaluation
Interpretation pearls
Transition point for obstruction
Pneumatosis portal venous gas concern
Cautions
Contrast nephropathy risk in severe CKD
Radiation risk in pregnancy
Ultrasound
Point of care ultrasound
Bowel obstruction evaluation
Dilated small bowel loops pattern
To and fro peristalsis pattern
AAA screening
Aortic diameter screening
Limited by bowel gas
Bladder volume
Urinary retention support
Obstructive uropathy pathway trigger
Special Tests
Bedside exams
Rectal bedside evaluation
Digital rectal exam findings
Hard stool burden
Empty vault despite severe symptoms
Anoscopy when bleeding
Hemorrhoids identification
Fissure identification
Procedural diagnostics
Nasogastric decompression response
High output gastric drainage
Symptom relief supports obstruction physiology
Specialty tests when indicated
Endoscopy and contrast studies
Water soluble contrast challenge
Partial small bowel obstruction pathway
Local protocol dependent
Colonoscopy
Malignancy evaluation pathway
Not for unstable patients
ECG
Indications
ECG utility
Significant electrolyte abnormalities concern
Syncope presyncope during straining history
Findings to monitor
Electrolyte related patterns
Hypokalemia related changes
Hyperkalemia related changes
Arrhythmia screening
Atrial fibrillation
Bradyarrhythmia
Assessment
Working diagnosis
Primary problem list
Constipation (K59.00)
No obstruction features
Benign exam pattern
Fecal impaction (K56.41)
Rectal stool burden
Overflow diarrhea possibility
Suspected bowel obstruction (K56.609)
Obstipation
Distension with vomiting
Severity and risk stratification
High risk features present
Peritoneal signs
Systemic toxicity
Significant dehydration
Low risk features present
Passing flatus
Tolerating oral intake
Complications to exclude
Complications
Bowel ischemia
Pain out of proportion
Metabolic acidosis pattern
Perforation
Free air concern
Peritonitis
Stercoral colitis
CT colitis findings
Fecaloma concern
Diagnostic uncertainty
Alternative diagnoses
Appendicitis
Diverticulitis
Renal colic
Plan
First 5 minutes
Initial stabilization workflow
Monitoring
Cardiac monitor for unstable or toxic appearance
Pulse oximetry
Vascular access
IV access for dehydration or vomiting
Two large bore IV for shock pattern
Immediate escalation
If peritonitis, immediate surgical consult
If shock, resuscitation bay transfer
Diagnostic sequencing
Test strategy
Low risk constipation
No routine imaging
Focus on rectal exam and response to therapy
Suspected obstruction or ischemia
CT abdomen and pelvis pathway
Lactate and CBC pathway
Therapeutics
Hydration and symptom control
IV fluids
Isotonic crystalloid bolus for dehydration
Reassessment after each bolus
Antiemetic
Ondansetron ODT 4 mg
Ondansetron IV 4 mg
Oral laxatives for low risk constipation
Polyethylene glycol
17 g in fluid once daily
Up to 34 g once daily short term if severe
Lactulose
15 mL to 30 mL orally once to twice daily
Flatulence and cramping risk
Senna
8.6 mg tablets
2 tablets at bedtime
Bisacodyl oral
5 mg to 10 mg once daily
Avoid in suspected obstruction
Rectal therapy when rapid effect needed
Bisacodyl suppository
10 mg rectally once
Onset within hours
Glycerin suppository
One suppository rectally
Useful in pregnancy
Enemas
Mineral oil enema
Warm water enema
Avoid sodium phosphate enema in CKD or heart failure
Fecal impaction pathway
Manual disimpaction
Topical lidocaine jelly
Analgesia or procedural sedation if needed
Post disimpaction regimen
Polyethylene glycol daily
Stimulant laxative short term
Suspected bowel obstruction pathway
Bowel rest
NPO
NG tube if persistent vomiting or significant distension
Resuscitation
Isotonic crystalloid
Electrolyte correction
Consultation
General surgery early
GI consultation for suspected malignancy obstruction when stable
Antibiotics when complication concern
If perforation concern, broad spectrum per local protocol
If ischemia concern, broad spectrum per local protocol
Reassessment loop
Interval reassessment
After each intervention
Pain trajectory
Nausea and vomiting trajectory
Objective outputs
Passage of stool
Passage of flatus
Escalation triggers
New peritoneal signs
Rising lactate or worsening acidosis
Disposition
ICU criteria
Critical care needs
Septic shock pattern
Hypotension after fluids
Vasopressor requirement
Suspected bowel ischemia with instability
Rising lactate with hypotension
Peritonitis
Inpatient admission criteria
Admission indications
Confirmed bowel obstruction
CT obstruction findings
Persistent vomiting
Stercoral colitis
CT colitis findings
Systemic inflammatory response
Failed ED disimpaction
Persistent severe symptoms
Inability to tolerate oral intake
Observation pathway criteria
Short stay candidates
Moderate dehydration responding to fluids
Partial obstruction under protocol
Need for repeated enemas with monitoring
Discharge criteria
Safe discharge features
No alarm features
Benign abdominal exam
Tolerating oral intake
Stool passage or clear improvement
Reliable follow up and return ability
Follow up timing
Follow up plan
Primary care within 3 to 7 days
GI referral within weeks for chronic or recurrent
Urgent referral for cancer concern features
Discharge Instructions
Copy discharge instructions
Diagnosis summary
Constipation
No signs of bowel blockage found today
Medications
Polyethylene glycol 17 g in fluid daily
Senna 2 tablets at bedtime as needed
Avoid additional laxatives if vomiting or worsening abdominal pain
Hydration and diet
Increase fluids
Increase fiber gradually
Activity
Walking daily if able
Avoid straining
Follow up
Primary care within 3 to 7 days
Earlier follow up if symptoms persist
Return to emergency
Severe or worsening abdominal pain
Vomiting that does not stop
Cannot pass gas
Fever
Blood in stool
New weakness or numbness
Trouble urinating
References
Guidelines and key sources
Core references
American Gastroenterological Association guideline on constipation 2013
American College of Gastroenterology clinical guideline on chronic idiopathic constipation 2023
Rome IV criteria for functional bowel disorders 2016
American Society of Colon and Rectal Surgeons practice parameters for constipation 2016
World Society of Emergency Surgery guidelines for acute colonic pseudo obstruction and volvulus 2017
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.