Table 3.

Alarm signs and symptoms of constipation[37]

Alarm signs	Symptoms of constipation
History	Constipation starting in neonatal period, delay pass meconium (> 48 h of life), family history of Hirschsprung’s disease
Stool characteristics	Ribbon stools, blood in the stools in the absence of anal fissures
Gastrointestinal features	Bilious vomiting, severe abdominal distension
Back	Sacral dimple, tuft of hair on spine, gluteal cleft deviation
Anus	Perianal fistula, abnormal position of anus, anal scar, absent anal/cremasteric reflex
Neurological features	Decreased lower extremity strength/tone/reflex
Others	Abnormal thyroid gland, fever, faltering of growth