Chronic constipation is one of the most common lower gastrointestinal disorders affecting people in the western world (Muller-Lissner et al, 2005), with far reaching economic consequences. In 2009, the cost of prescribed laxatives was more than £60 million for primary care in England alone (NHS Business Services Authority, 2009), with many more laxatives being bought directly overthe-counter. These facts demonstrate the need for nurses to possess the skills and knowledge to assess constipation competently to make a clear diagnosis. If pharmacological interventions are required, it is essential that all nurses (especially those who prescribe) are not only conversant with laxatives recommended by local prescribing formularies, but with all other alternative treatment modalities as well. Constipation is characterized by a real or perceived change in normal bowel habit that is unsatisfactory because of both infrequent and difficult passage of hard stools, or feelings of incomplete defecation. Constipation is multifactoral, often with complicated underlying pathophysiology, and can be influenced by physical, psychological, physiological, emotional and environmental factors. A patient with constipation may experience a variety of symptoms. These can range from headache and fatigue to feelings of bloatedness, and/or loss of appetite leading to nausea and vomiting. Patients with cognitive impairment may also present with increased physical and verbal aggression owing to their constipation (Leonard et al, 2006). The consequence of persistent or poorly managed constipation can lead to disabling complications for the patient such as haemorrhoids, faecal impaction, faecal impaction with spurious overflow, urinary incontinence, bladder outlet obstruction, urinary tract infection, rectal bleeding, general weakness and psychological disorders. Persistent straining at stool results in increased intrathoracic pressure, which can give rise to a reduction in coronary and peripheral circulation leading to other possible complications, e.g. the development of hernias, worsening of gastrooesophageal reflux, and transient ischaemic attacks. Assessing patients with constipation presents many challenges to the health professional in overcoming communication barriers associated with bowel habits and the embarrassment associated with an intimate rectal examination. Also, as constipation may not result from a single straightforward cause, assessment is based on consideration of all possible causes, checking in particular that it is not caused by an underlying undiagnosed medical condition. Evidence-based guidelines (National Institute for Health and Clinical