No recent textbook has comprehensively addressed this topic, but many gastroenterology and colorectal surgical texts do the job more succinctly. Although the editors, who are colorectal surgeons, consider the book to be multidisciplinary, most of the contributors are surgeons. This perspective is shown in various ways; for example, anismus is usually referred to as paradoxical puborectalis contraction, a misleading construct. This text is intended for colorectal and general surgeons, gastroenterologists, and, to a "certain degree," gynecologists and psychiatrists. It is contradictory that a textbook on constipation, a common and poorly understood problem that is rarely treated surgically, should not be valuable for primary care physicians. A broader view of the subject—with less emphasis on the details of diagnostic procedures and surgery—would have significantly enhanced the book's value for internists.

The book has an attractive format and is easily read, but the quality of the contributions is spotty. Figures are often needlessly large and repetitive, but tables summarizing various studies are usually helpful. As with many multiauthor texts, there is considerable redundancy, such as three algorithms for the evaluation of the constipated patient and sequential chapters on methods to measure small-bowel and colonic transit and on colonic and small-bowel transit studies.

There are high points. Kiupers's chapter on defecography is appropriately restrained in appraising the clinical utility of this technique, but his conclusion is less tempered. In contrast to conventional dogma, Duthie and Bartolo's experience with colectomy for severe colonic inertia suggests that findings indicative of anismus do not predict poor results. Devroede, a biopsychosocially oriented colorectal surgeon, emphasizes the importance of that viewpoint in severe chronic constipation.

There are several deficiencies. The absence of in-depth coverage of the normal anatomy and physiology of colonic transit and defecation and of the common problem of encopresis is significant. These topics are covered only superficially and in bits and pieces. The increasingly accepted concept that psychopathology determines health care-seeking behavior more than do specific gastrointestinal (or other somatic) symptoms is hardly addressed. Strangely, the well-documented frequent history of childhood sexual abuse in functional lower gastrointestinal disorders is barely touched on in chapters on evaluation and psychiatric treatment. No reference is made to the treatment of anismus with botulinum toxin.

Several errors in terminology are disconcerting. These include "incidence" for frequency; colonic "peristalsis" (colonic movements are not peristaltic); "obstipation" defined as "pain with bowel movements"; and rectal contractions referred to as "waves" (a term reserved for myoelectric, not mechanical, activity).

From an internist's perspective, some of the contributions are useful, but similar data and opinions that are at least as current as those presented here can be found in other textbooks.