The economic impact of constipation is large. The condition prompts an estimated 2.5 million physician visits per year, with 100,000 referrals to gastroenterologists. Almost all (85%) of these physician visits result in a prescription for a laxative. Each year, Americans spend $800 million on laxatives. For patients referred for diagnostic evaluation, the average cost is $3000, mostly due to the cost of colonoscopy. This article discusses the pathophysiology of constipation and presents a practical approach to evaluating and treating this disorder.