Background The rapid increase in the global aging population poses a major public health challenge due to the prevalence of stroke. Constipation represents a significant complication of stroke, significantly impacting quality of life. The objective of this study is to investigate the incidence of constipation in acute stroke and to identify the factors that contribute to new-onset constipation (defined as constipation developing after stroke in patients with no prior history) after stroke. Methods A total of 600 acute stroke patients were recruited for a cross-sectional study, with a questionnaire administered to each participant. This study included demographic characteristics, stroke type and focus, medical history, sleep quality, psychological problems, and the NIHSS and Barthel index (BI). Participants with constipation were evaluated for severity, medications, and stroke outcomes at discharge by the investigators. Results Of the 600 acute stroke patients, 126 (21%) reported a history of constipation. Furthermore, 278 patients (46.3%) demonstrated post-stroke constipation (PSC), while 184 patients (38.8%) experienced new-onset constipation following their stroke. The results indicated that hemorrhagic stroke, posterior circulation stroke, diabetes, osmotic diuretics, antacids, use of bedpans, Difficulty falling asleep, depression, and a higher NIHSS score at admission were significant risk factors for new-onset constipation. In patients demonstrating moderate severity, PSC correlated with adverse stroke outcomes at discharge. Conclusion The incidence of constipation in acute stroke patients is higher than that in the general population. The results suggest that depression and Difficulty falling asleep may increase the risk of new-onset constipation. Moreover, after adjusting for confounders, new-onset constipation was independently associated with poor discharge outcome, particularly in patients with moderate stroke severity. Early identification of constipation risk in stroke patients can improve the development and optimization of rehabilitation protocols. Clinical trial registration Identifier ChiCTR2400080663.
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