Objective To summarize the clinical characteristics of the elderly ischemic colitis (IC) with constipation in order either to better instruct clinical practice or to avoid misdiagnosis or missed diagnosis. Methods A total of 160 elderly IC patients (35 males and 125 females) hospitalized in our department from 2008 to 2013 were observed and retrospectively analyzed. According to the presence of constipation, the 160 patients were divided into 2 groups: constipation group and non-constipation group. The underlying conditions, clinical manifestations, misdiagnosis, laboratory examination results, endoscopic findings, pathological observation, clinical course, and outcomes after treatment were analyzed and compared between the 2 groups. Results There were 92 patients out of 160 IC (57.5%) suffering from constipation. Compared with the IC patients without constipation, those with constipation were younger, and had atypical clinical manifestations, higher misdiagnosis rate (48.8%), and worse colonic lesions. After 2-week treatment, the rate of complete mucosal healing was lower in the patients with constipation than those without (63.0% vs 79.9%). The bowel lesions in the left colon accounted for 78.3% in the patients with constipation, and 75.0% in those without, and the amount was similar between the 2 groups. Conclusion Chronic constipation is quite common in the elderly IC patients, and is also an important risk factor for IC. The patients of IC with chronic constipation usually have atypical clinical manifestations. For the chronic constipation patients accompanied with multiple comorbid diseases, such as hypertension, coronary heart disease and/or diabetes, strong vigilance should be paid for their abdominal pain or hematochezia, and colonoscopy should be performed as early as possible to make correct diagnosis.