Constipation is reported increasingly with age and is more common in females than in males. A search for potentially treatable causes of constipation should always be undertaken, with particular attention being paid to diet, disability, drug use, metabolic causes and anorectal disorders. The diagnosis can usually be made from the history and physical findings, although a plain x-ray of the abdomen is often helpful. Constipation of recent onset deserves a thorough investigation, particularly when it occurs in association with other lower gut symptoms. Most elderly patients complaining of a recent onset of constipation will respond to advice, attention to diet, fibre supplementation and increased mobility. An increase in fibre intake should be complemented with an adequate fluid intake. An osmotic laxative may be required for long standing refractory constipation, but stimulant and other non-osmotic laxatives should be avoided. (author abstract)
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