• Constipation, a prevalent gastrointestinal disorder, manifests as infrequent defecation (fewer than three bowel movements per week), hard stools, excessive straining, sensation of incomplete evacuation, or obstruction.� In proctological practice, it often precipitates anorectal conditions like hemorrhoids, anal fissures, and rectal prolapse due to prolonged straining and stool retention.� Allopathic management prioritizes etiology identification—distinguishing functional (chronic idiopathic constipation, CIC) from secondary causes (e.g., opioids, hypothyroidism)—followed by stepwise pharmacotherapy.��PathophysiologyDelayed colonic transit, pelvic floor dyssynergia, or rectal evacuation disorders underlie most cases.� In CIC, reduced peristalsis stems from enteric nervous system dysfunction or serotonin signaling deficits (5-HT4 receptor downregulation).� Proctologists assess via anorectal manometry, balloon expulsion testing, or colonic transit scintigraphy to differentiate slow-transit constipation from outlet obstruction.�Nonpharmacologic InterventionsInitial therapy emphasizes lifestyle modifications: high-fiber diet (25-30g/day psyllium or bran), adequate hydration (2-3L/day), and physical activity to enhance gastrocolic reflex and fecal bulk.�� Biofeedback retrains pelvic floor coordination in dyssynergic defecation, achieving 70-80% success in outlet disorders.� These measures suffice for mild cases but require escalation in refractory CIC.�Pharmacologic RemediesBulk-forming laxatives (psyllium, methylcellulose) increase stool water content via osmosis; osmotic agents like polyethylene glycol (PEG, 17g daily) or lactulose normalize frequency with NNT=3.�� Stimulants (bisacodyl, sodium picosulfate) provoke peristalsis for acute relief; chronic use risks dependence.� Prokinetics include prucalopride (2mg daily, 5-HT4 agonist) and linaclotide/plecanatide (guanylate cyclase-C agonists), improving transit in 30-40% of failures.��Advanced TherapiesFor opioid-induced constipation, peripherally acting mu-opioid antagonists (methylnaltrexone, naloxegol) restore motility without analgesia loss.�� Lubiprostone (chloride channel activator) secretes intestinal fluid.� Refractory cases warrant proctologist evaluation for subtotal colectomy in confirmed slow-transit pathology, though morbidity limits use.� Monitoring electrolytes and overflow diarrhea is essential.�