An accurate diagnosis is of primary importance in lower gastrointestinal problems in the elderly. Reversible causes should be treated specifically whenever possible, but symptomatic treatment can be a useful adjunct or a mainstay if no cause can be found. For constipation symptomatic treatment should proceed stepwise, commencing with increase in dietary fibre content. Only if this approach fails should laxatives (osmotic) be used. Stimulant laxatives and paraffin are best used intermittently, if at all, because of their side effects.