Constipation is a common and complex clinical symptom, mainly refers to the reduction in the number of bowel movements, reduced stool volume, dry stool and straining to defecate, etc. When two or more of the above symptoms exist at the same time, it can be diagnosed as symptomatic constipation. So what should I do if I have constipation? Does all constipation require surgical treatment? In fact, most patients’ constipation symptoms can be relieved by changing lifestyle habits, adjusting dietary structure and supplementing with medication, only some patients with persistent constipation eventually need surgery. Most of the constipation requiring surgery is exit-obstruction constipation, i.e., fecal discharge obstruction due to muscle incoordination in the abdomen, anorectum and pelvic floor. The etiology is complex, and at least the following are recognized: anterior rectal protrusion, internal rectal mucosal prolapse, perineal descent syndrome, puborectalis syndrome, internal sphincter dystocia, external sphincter dystocia syndrome, pelvic floor hernia, etc., which can be confirmed by specialized examinations such as fecal imaging. For this type of constipation, surgical treatment is more reliable, and the clinical treatment results are more satisfactory as long as the indications are mastered. The principle is to remove the cause of constipation difficulties to the maximum extent possible, and to achieve minimally invasive, safe, reliable and less complications. Slow-transmission constipation, i.e., difficulty in defecation caused by poor peristaltic function of the large intestine, was considered a functional disorder in the past, but recent studies have increasingly shown that slow-transmission constipation actually involves pathological changes in the nerve plexus in the intestinal wall, such as neuronal degeneration and a decrease in the content of the associated enteric neurotransmitters. Therefore, surgery is gradually considered as the ultimate treatment for intractable slow-transmission constipation, and currently the more mature and effective surgical procedures include total colectomy and subtotal colectomy. Considering that this type of surgery is more traumatic, the more consistent view in the treatment of slow-transmission constipation is that conservative drug treatment is preferred for six months to a year, or even longer, and only when conservative treatment finally proves ineffective and the patient’s clinical symptoms are more severe should surgery be considered carefully. However, it is difficult to avoid severe postoperative diarrhea in the short term, which is often controlled by continuous medication to slow down bowel movement. It can be seen that for most patients with constipation, good results can be achieved through lifestyle modification, improvement of dietary structure, and appropriate exercise, supplemented by appropriate medications. For those patients who cannot be relieved by regular conservative treatment, surgery may be the only means to cure their constipation.