SUMMARYBackground: Laxatives are frequently ineffective in treating constipation. An alternative therapeutic approach is to target serotonin-4 receptors, which are involved in initiating peristalsis. Aim: In a double-blind, placebo-controlled trial, to assess the efficacy and safety of a systemically active serotonin-4 agonist, prucalopride. Methods: Seventy-four women with constipation were stratified into slow or normal transit groups, and each group was randomized to receive either placebo or 1 mg prucalopride daily for 4 weeks. A bowel function diary was maintained. Whole-gut and orocaecal transit, visceral sensitivity, quality of life and psychological state were assessed before and after treatment. Results: Prucalopride, not placebo, increased spontaneous stool frequency (P ¼ 0.008) and reduced time to

Most patients with faecal incontinence require only a full history (information about other predisposing causes) and examination (assessment for faecal impaction and evaluation of sphincter function and structure). When necessary, anorectal physiological studies, endoanal ultrasound and magnetic resonance imaging allow accurate characterization of sphincter function and structure.

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: Potential endosonographic markers for external anal sphincter atrophy are suggested, and a visual scale for endocoil magnetic resonographic assessment has been validated.

Behavioural retraining, including biofeedback, improved symptoms in most patients with idiopathic megarectum. In some patients symptoms completely resolved, without the need for laxatives. Although further studies are necessary in terms of both larger number of patients and longer follow-up period, behavioural treatment may be useful for such patients.