#### Summary points Chronic constipation in adults is a common and often debilitating problem that may present to almost any medical practitioner as it can have many causes. The most recent Rome criteria provide a useful research and clinical tool for defining chronic, functional constipation (box 1).1 For the problem to be described as chronic, the Rome criteria need to have been met for the previous three months, with the onset of symptoms six months prior to diagnosis. We prefer a more inclusive definition of chronic constipation: any patient experiencing consistent difficulty with defecation. This review examines the evidence for the modern approach to treating chronic constipation and is based largely on systematic reviews and randomised controlled trials where these are available. #### Box 1 Rome criteria* Since the most recent Rome criteria were published, a well conducted Spanish epidemiological study found that the prevalence of self reported constipation was 29.5% yet only half of those met the Rome criteria.2 This …