The Rome IV criteria for primary chronic obstipation help to distinguish between short-term ailments and a chronic pattern of complaints 1. In general, there are several causes of defecation disorder in the age group of the elderly. Anamnesis and observance of red flags in addition to a geriatric basic assessment make it possible to narrow down the causes. The distinction between low-transit constipation and normal intestinal function can decisively influence the therapeutic consequence.
 In the drug intervention, osmotic laxatives, stimulating laxatives, suppositories and enemas with different additives are still used very frequently. In the second place, the prokinetic prucaloride and for some years methylnaltrexonium bromide can be used as a representative of the peripheral-acting opioid receptor antagonists 2 3. Fibre-rich diet produces more bowel movement and prebiotic additives can influence the microbiome favorably. Additional fibre is not likely to show benefit in case of severe constipation, in particular to patients with low-transit constipation or defecation disorders. When preparing for colonoscopies, it appears that additional movement activation has positive effects on the quality of intestinal cleansing 4.

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