About $250 million a year are spent on laxatives in the United States, attributable in large portion to the elderly. However, before laxative therapy is started in these patients, adequate exercise, ample fluids, and a high-fiber diet should be recommended. If these measures are unsuccessful and underlying disease is excluded, laxative use may be considered. Selection of the most appropriate cathartic for the clinical situation is vital. Bulk-forming laxatives and lactulose are favored. Dietary and drug intake should be discussed with the patient and constipating items eliminated when possible. Enema therapy may be necessary to retrain or evacuate an atonic, constipated colon. The mnemonic, right, summarizes the major points in treating constipation.