Compared to “cancer,” chronic constipation has not attracted much attention from general clinicians, but our online survey showed that 64% of physicians interested in the topic of constipation found it difficult or very difficult to treat, and only 10% adopted good bowel habits as a means to improve constipation, which is a good indication that emphasis should be placed on These suggest that emphasis should be placed on the rational management of chronic constipation. In fact, constipation is a common symptom encountered in the clinical practice of general clinicians, such as diabetes, endocrine diseases, post-surgery, pregnant women, elderly, children, tumors, etc.; constipation may play an important role in the occurrence of hepatic encephalopathy, breast disease and Alzheimer’s disease, etc. Excessive forceful defecation may even induce acute cardiovascular and cerebrovascular accidents. For patients with chronic constipation, constipation is no longer just a clinical symptom, but a disease that plagues their mental and physical health. Most patients with severe constipation have varying degrees of psychosomatic abnormalities and have a poor quality of life. Constipation is a subjective symptom described by the patient. In addition to the common textbook symptoms of decreased frequency of bowel movements (less than 3 times per week), dry and hard stools, difficulty in defecation (straining to defecate, difficulty in passing stools, feeling of incomplete defecation, time consuming defecation), patients often also report the need for assisted defecation (medication, enema, manipulation), decreased bowel movement or lack of bowel movement, inability to defecate when they want to, low volume of defecation, anal obstruction, etc. Clinicians should carefully question patients about their subjective feelings, not only analyzing the common symptoms of constipation, but also focusing on those unconventional feelings of constipation, such as thin stools with no sense of emptying. It is crucial to accurately choose a reasonable way to manage patients with chronic constipation, focusing on the tests to be chosen, the laxative drugs to be chosen, the psychological status and antipsychotic treatment to be chosen, and the timing of surgical procedures to be chosen. I. What kind of patients need to be examined? What types of tests are needed? Because constipation may be a manifestation of organic diseases, clinicians tend to exclude constipation caused by organic diseases first, they are afraid to diagnose functional constipation, they are not sure about the diagnosis, and they are used to seeking pathological evidence, making functional constipation an “exclusive diagnosis”, so that clinicians have to prescribe various tests, leading to Unnecessary tests, or even excessive tests. A large number of clinical follow-up studies have demonstrated that the error rate for symptom-based diagnosis of functional gastrointestinal disorders is relatively low, and that a diagnosis can be made as long as the diagnostic criteria for functional constipation are met. For experienced doctors, anorectal finger examination can not only understand the presence or absence of anorectal masses, but also the function of the anal sphincter and puborectal muscle. Patients are asked to imitate defecation movements and try their best to expel their fingers, which are normally relaxed, and if the fingers are clamped, it indicates the possible existence of uncoordinated contraction of the anal sphincter. The Chinese guidelines for the diagnosis and treatment of chronic constipation emphasize the indications for examination: patients aged >40 years with chronic constipation with alarm signs or alarm signs appearing during follow-up, such as blood in stool, positive fecal occult blood, fever, anemia and weakness, emaciation, obvious abdominal pain, abdominal mass, elevated blood carcinoembryonic antigen, history of colorectal adenoma and family history of colorectal tumor. The examination mainly includes colorectal microscopy, abdominal and pelvic imaging, fecal routine + occult blood, blood routine + tumor markers. In patients with functional constipation, colorectal function and anal function should be understood when 2 to 4 weeks of empirical treatment is ineffective. Gastrointestinal transit time measurement (GITT) is a classical examination of colonic power function; and for anorectal function examination is mainly to understand whether rectal and anal movements are coordinated, balloon forcing out test is a simple primary screening test, fecal imaging can reflect rectal/pelvic floor morphological structure and defecation function in more detail, and anorectal manometry is to understand coordinated rectal and anal movements, rectal propulsion force and sensory function. Second, how to choose treatment measures? Why is individualization emphasized? The selection of laxatives should take into account evidence-based medicine, safety, drug side effects, cost effectiveness, and also the typology of constipation (slow transmission type or defecation disorder type) and the severity of constipation to avoid abuse. Doctors treating constipation mostly consider drugs, and quite a few of them do not know that the real purpose of constipation treatment is to restore normal intestinal dynamics and bowel function, but it should be emphasized that reasonable diet, water intake, exercise, and establishment of good bowel habits are the basic treatment of chronic constipation, and only with the establishment of good bowel habits can the symptoms of constipation be truly and completely resolved, otherwise constipation will be accompanied by a lifetime. Patients with insufficient fiber intake in their daily diet should be given adequate supplements first. Biofeedback training is an effective treatment for patients with constipation due to pelvic floor muscle dysfunction and can help these patients establish good defecation habits, and biofeedback training can also improve patients’ psychological status and quality of life. Individualization in the treatment of constipation is very important. Constipation is typed differently, its pathophysiological changes are different, and the choice of treatment is bound to be different; the individual differences in symptoms are great, and the goal of our treatment is to relieve symptoms; the intermittent nature and fluctuating severity of symptoms require physicians to adjust the treatment plan in real time; multiple symptoms overlap with each other, requiring consideration of integrating different targets of treatment; and there are significant gender and individual differences in the efficacy of drugs. When is it necessary to evaluate psychological status? How to choose psychosomatic treatment? When the patient’s constipation is fully understood, the psychological status needs to be evaluated in time to assess the impact of constipation on the quality of life. The Chinese constipation guidelines suggest that initial psychological assessment should be conducted at the time of primary diagnosis and treatment, and for patients with refractory constipation, the intervention of a psychologist should be considered to determine the psychological status in a timely and accurate manner. Patients with psychological disorders and insomnia should be given psychological guidance. Doctors must fully recognize the importance of good psychological status and sleep in relieving constipation symptoms, and patients with significant psychological disorders should be treated with antidepressant and anxiety medication and receive specialist treatment if necessary. Treatment emphasizes individualization, comprehensive treatment, and graded treatment, and attention must be paid to maintaining an adequate course of treatment, paying attention to individual differences in sensitivity and tolerance, and adjusting the dose and drug ratios in real time. The timing of surgical treatment Internal medicine doctors tend to surgical treatment as the last option, especially for refractory patients, should not easily choose surgical treatment, not many patients really need surgery, whether it is structural abnormalities of the rectum (rectal prolapse, rectal prolapse), or pelvic floor spasm syndrome, slow transmission type constipation should first choose the correct standardized internal medicine treatment. Medications still need to be maintained until normal bowel dynamics and bowel function are restored after surgical procedures.