There is no more troublesome symptom in derangements of the digestive organs, nor any more difficult to overcome, than habitual constipation.—R. J. Graves, Clinical Lectures on the Practice of Medicine, 1884¹

The treatment of constipation is generally considered a simple patient management issue and is frequently delegated to the least experienced member of a health care team (ie, medical student, intern, nurse). Yet for some patients, especially in the elderly population, constipation remains a very important problem and may be very difficult to manage. The reason why this becomes such a chronic problem refractory to management is most likely a result of environmental factors such as lifetime behavior of bowel habits, dietary habits, and laxative use along with the interaction of the pathophysiologic and, perhaps, some senescent changes of gut motility. However, a lack of physicians' interest and inadequate training in treating constipation may be pivotal in