INTRODUCTION. This review focuses on the approach andtreatment of chronic constipation, non-pharmacological and pharmacological, in the elderly. METHODS. Pubmed searches were made for paperspublished between 2004 and 2009 using the key words of “chronic constipation” and “elderly”. Relevant papers were shortlisted for further study. Supplementary searches were made to obtain local statistics, and for references cited in the shortlisted papers. RESULTS. Chronic constipation can be due to primary disease processes ( f unctional bowel disorders), medication induced causes, and secondary causes. In the absence of secondary causes and medication induced causes, lifestyle changes, fibre supplements and simple osmotic laxatives (lactulose, or PEG 3350) are likely to be adequate. Magnesium hydroxide, polycarbophil, methylcellulose, senna, bisacodyl, decusate preparations, bran, colchicine, misoprostol, and lubricants which are given Grade B recommendations by American College of Gastroenterology are alternatives. Enemas, suppositories, and biofeedback exercises have a place in dyssynergic defaecation disorders. Prucolapride and lubiprostone show promise but studies in the elderly are needed. Tagaserod was voluntarily withdrawn by the manufacturer because of cardiovascular adverse effects. Intractable constipation may need surgery. CONCLUSIONS. In the elderly with chronic constipation,history and physical examination to exclude medication induced constipation and secondary causes are the first step. For those with functional bowel disorders, lifestyle alterations, fibre, and osmotic laxatives remain the staple management strategies. For those with pelvic dyssynergia, biofeedback should be considered. Surgery may be needed for those with intractable chronic constipation.