Constipation--a sign of a disease to be treated surgically, or a symptom to be deciphered as nonverbal communication?

Constipation is not a sign but a symptom, which is not measurable scientifically. It has emotional components and must be dealt with in a holistic manner. The scientific approach aims only at the physiological derangement and serves to place the complaint in a more objective perspective. An algorithm can be constructed to select treatment including surgery, but there is no gold standard at present because the natural history of the symptoms is unknown. Most physicians confuse normality with epidemiology, neglecting in the process the evolution of mankind in terms of behavior. Constipation now means less than five stools per week, while it used to mean three. Thus, all complaints should be addressed. As for surgery, it should be performed in few, high select patients with no dysfunction other than that in the colon and in conjunction with a fully normal thorough psychological evaluation.