Red flags Certain findings raise suspicion of a more serious etiology of chronic constipation: Distended, tympanitic abdomen Vomiting Blood in stool Weight loss Severe constipation of recent onset / worsening in older patients Interpretation of findings Certain symptoms (eg, a sense of anorectal blockage, prolonged or difficult defecation, need for digital disimpaction), particularly when associated with abnormal (ie, increased or reduced) perineal motion during simulated evacuation, suggest a defecatory disorder.