Urgent Care Evaluation and Management of Constipation

Publication Date: February 2026 (Volume 5, Number 2)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 02/01/2029.

Update Author*

Joseph Toscano, MD

Urgent Care Physician, John Muir Urgent Care, Walnut Creek, CA; Emergency Physician, San Ramon Regional Medical Center, San Ramon, CA

Peer Reviewer

Sean M. McNeeley, MD, FCUCM

Medical Director, Occupational Medicine, University Hospitals, Cleveland, OH; Clinical Instructor, Case Western Reserve University School of Medicine, Cleveland, OH

Abstract

Most cases of constipation are benign, but serious complications, such as fecal impaction and stercoral colitis, can occur. Data about how often patients present to urgent care with this complaint, as well as evidence to guide the evaluation and treatment of these patients, are limited. Many of the decades-old treatments have not been studied in modern, rigorous, controlled trials. Constipation is a clinical diagnosis, but one of exclusion, and ideal management includes evaluation for dangerous mimics or complications and, for most patients, discharging the patient with a bowel regimen tailored to the likely cause of their constipation, with appropriate referral to primary or specialty care. This review evaluates consensus guidelines on management of constipation as well as the early data on the newer prescription medications for chronic and opioid-induced constipation.

Case Presentations

CASE 1

An 85-year-old woman is brought into urgent care by her son who is worried she may “have another UTI”…

The patient has a history of diabetes, stroke, and mild dementia.
The patient’s son reports that she is usually alert and oriented to person and place, but today she seems weak and confused and is barely talking.
She hasn’t had a bowel movement in 5 days, even after getting an enema yesterday.
On examination, she is tachycardic with a nontender but mildly distended abdomen. Her vital signs are: temperature, 37.3°C; heart rate, 114 beats/min; blood pressure, 104/58 mm Hg; and oxygen saturation, 94% on room air.
You wonder whether an episode of simple constipation could make someone this sick…

CASE 2

A 28-year-old woman who is 30 weeks pregnant presents to urgent care with decreased bowel movements and moderate crampy and sometimes sharp lower abdominal discomfort for several hours...

The patient says she has “not had a decent BM” in weeks, and the pain started as she strained, unsuccessfully, to have a bowel movement.
She notes that she is taking oral iron supplementation for anemia, which got worse with her pregnancy.
She is slightly tachycardic but afebrile, with otherwise normal vital signs. Her examination shows moderate tenderness in the right mid- and lower abdomen.
You wonder if this is a simple case of constipation related to iron supplementation or whether the patient requires imaging….

CASE 3

The parents of a 7-year-old boy bring him to urgent care after several hours of intermittent crampy lower abdominal pain...

He has had no fever, nausea, or vomiting. They note that about a year prior, he had similar pain and that an enema given in his pediatrician’s office alleviated the problem, but his pediatrician is not available today.
His vital signs are normal, and his examination reveals only minimal left lower abdominal tenderness. Genital examination is normal with nontender testes.
You wonder if an x-ray is needed to confirm the diagnosis and whether an enema is reasonable to give in this case...

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