[Chronic constipation--what to do?]

Chronic constipation implicates heterogeneous disturbances of colonic transit and defecation which require both, careful medical evaluation and therapy. While the modes of action and side effects of laxatives are known for years, the understanding of dysfunctions underlying chronic constipation appears to be related to the understanding of subtle and new investigative techniques. This and the former extent of laxative prescriptions may explain why (based on an 'ex cathedra' decision by the governmental and insurance companies) the prescription of laxatives among primary care practitioners (in Germany) is not acknowledged as medical therapy. How to continue? First: two steps back, reestablishing understanding of constipation as a disease, including subtle diagnosis and differential diagnosis; then; two steps ahead, towards specific therapy, being aware that the available drugs are effective and require prescription by an experienced physician.