Red Flags & Referral Criteria

Safety Assessment

Check any alarm features present. Click Why is this a red flag? to understand the clinical significance and why each finding demands attention.

Emergency — Immediate Action Required

Signs of bowel obstruction (absolute constipation, vomiting, distension, severe pain)

Signs of peritonitis (rigid abdomen, rebound tenderness, fever, tachycardia)

Rectal bleeding or hematochezia

Unintentional weight loss

Iron deficiency anemia with constipation

Acute or new onset constipation in adults > 50 years

Progressive narrowing of stool caliber

Family history of colorectal cancer with new constipation symptoms

Palpable non-fecal abdominal or rectal mass

Constipation refractory to first-line therapies (fiber + osmotic laxatives)

Fecal impaction on digital rectal exam

Suspected pelvic floor dyssynergia (paradoxical contraction on DRE)

Opioid-induced constipation not responding to conventional laxatives

No alarm features identified

Safe to proceed with standard evaluation and management of functional constipation

Gastroenterology

Refractory constipation, suspected organic cause, need for anorectal physiology testing

Colorectal Surgery

Suspected obstruction, rectal mass, consideration of surgical intervention for slow transit

Pelvic Floor Physiotherapy

Confirmed dyssynergic defecation for biofeedback therapy (70% success rate)

Oncology

Confirmed or suspected colorectal malignancy on investigation