What Symptoms Should You Watch For?
Constipation by itself is extremely common. But constipation accompanied by certain symptoms should receive more attention.
1. Severe or worsening abdominal pain
Mild discomfort can occur with ordinary constipation. Persistent, severe, or progressively worsening abdominal pain is different.
NIDDK recommends seeking medical attention promptly when constipation occurs with constant abdominal pain.
2. Increasing abdominal swelling
A noticeably distended abdomen—particularly when the swelling continues to increase—can occur with intestinal obstruction and volvulus.
In the published young-woman case, progressive abdominal distension was one of the key features that ultimately pointed toward the diagnosis.
3. Inability to pass gas or stool
A bowel obstruction can prevent both stool and gas from moving through the intestine.
NIDDK specifically lists an inability to pass gas as a reason to seek medical care promptly when constipation is present.
4. Nausea or vomiting
Vomiting together with constipation, abdominal pain, and swelling can be a warning sign of intestinal obstruction.
Volvulus commonly presents with some combination of abdominal pain, bloating, constipation, nausea, and vomiting.
5. Symptoms that suddenly become much worse
Someone who has experienced constipation for a while but then develops sudden severe pain, rapidly increasing abdominal distension, or vomiting should not simply take more laxatives and wait.
Those symptoms can indicate an obstruction or another acute abdominal problem that requires medical assessment.
What Does an X-Ray Show?
Imaging can be extremely helpful when doctors suspect a bowel obstruction.
An abdominal X-ray may reveal characteristic patterns associated with sigmoid volvulus. One classic appearance is called the “coffee bean” sign, caused by the markedly enlarged, twisted sigmoid colon.
However, an X-ray does not always provide the complete answer. In the 33-year-old woman's case, the initial X-ray could mimic fecal impaction, while CT imaging revealed the characteristic signs of volvulus.
NIDDK notes that doctors may use X-rays, CT scans, or other imaging studies when evaluating suspected colonic volvulus.
Why Chronic Constipation Shouldn't Always Be Ignored
Most constipation is not caused by an intestinal obstruction.
Common causes include insufficient fiber or fluids, low physical activity, certain medications, changes in routine, and functional gastrointestinal disorders.
But persistent constipation can sometimes be a symptom of an underlying medical condition.
NIDDK recommends talking with a healthcare professional when constipation does not improve with self-care or continues for a long time.
The goal is not to become alarmed by every episode of constipation. Instead, it is to recognize when the symptoms are unusual, persistent, or accompanied by warning signs.
When Should You Seek Urgent Care?
If constipation occurs together with constant or severe abdominal pain, significant abdominal swelling, vomiting, fever, blood in the stool, unexplained weight loss, or an inability to pass gas, medical evaluation is important.
If symptoms suggest an intestinal obstruction—particularly severe pain, vomiting, marked distension, and inability to pass stool or gas—seek urgent medical attention rather than trying to treat the problem at home.
A volvulus can compromise blood flow to the intestine, and untreated complications can become life-threatening.
The Takeaway
The story of the 33-year-old woman is unusual, but it carries an important lesson: being young and otherwise healthy does not make serious intestinal problems impossible.
Her symptoms initially suggested constipation and possible stool impaction, but further imaging revealed a twisted sigmoid colon.
Most people with constipation will never develop a volvulus. Still, constipation accompanied by progressive abdominal swelling, severe pain, vomiting, or inability to pass gas or stool should never be casually dismissed.
Sometimes, the difference between ordinary constipation and a medical emergency is not how the problem starts—but how the symptoms change over time.
If your constipation is persistent or suddenly becomes much worse, especially with severe abdominal symptoms, contact a healthcare professional promptly.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — Colonic Volvulus.
- NIDDK — Symptoms & Causes of Constipation.
- PubMed / The Journal of Emergency Medicine — Sigmoid Volvulus in a Young Woman Nearly Misdiagnosed as Fecal Impaction.
- Surgical Case Reports — A case of sigmoid volvulus in an unexpected demographic.
- Frontiers in Surgery (2026) — Sigmoid volvulus and incidental enterobiasis in a young adult: a case report.
