Based on the preceding review, an algorithmic approach to patients with constipation can be devised. See Algorithms 1 to 3 in the preceding medical position statement. After the initial history and physical examination, it should be provisionally possible to classify patients into one of several subgroups. Standard blood tests (complete blood cell count, thyroid-stimulating hormone, calcium) are widely used and inexpensive. The yield of these tests has not been evaluated but is likely very low. Whether these tests should be routinely performed in all patients is debatable. When appropriate, a colonic structural evaluation (colonoscopy or flexible sigmoidoscopy and barium enema or computed tomographic colonography) should be performed to rule out organic causes of the constipation. Patients with known neurologic conditions need these to be addressed. If the initial evaluation is normal or negative, an empiric trial of fiber (and/or dietary changes) can be followed by over-the-counter osmotic or stimulant laxatives. Many patients will obtain symptom relief with these measures, which are safe for long-term use. Patients who fail to respond to this initial approach are appropriate candidates for more specialized testing. Pelvic floor dysfunction needs to be excluded by performing anorectal manometry and a balloon expulsion study, followed by defecography if necessary. Biofeedback therapy is the cornerstone for managing pelvic floor dysfunction. A simple and inexpensive radiopaque marker study will identify STC, which should be treated with aggressive laxative programs and, where available, prokinetic agents. Truly refractory patients may be considered for surgery, although few will qualify after more extensive physiological studies. Many patients will have normal studies, and most will meet the criteria for IBS-C. The hope is that most of these patients can be managed with laxatives and reassurance. As with other functional gastrointestinal disorders, psychological conditions need to be considered as contributing factors. Key to their adequate management is identification of the predominant symptom: is this constipation or the associated symptoms (bloating, pain, nausea, and so on)? Unfortunately, the clinical effectiveness and the cost effectiveness of this algorithmic approach have not been assessed. The structural evaluation, at least in older patients, is likely cost-effective on the basis of identifying colon cancer and adenomatous polyps. Laxatives, biofeedback, and surgery have all been shown to be effective in treating selected patients. Community-based physicians will likely perform the evaluation sequentially, whereas tertiary centers may need to test more simultaneously for patient convenience. Many of the specific points of our algorithm may be debated, and different algorithms certainly have not been compared for clinical or cost benefits. The goal of this review was to guide practicing gastroenterologists through rational and efficacious approaches to patients with constipation.