Chronic constipation (CC) is widely prevalent in the Western world, with a significant negative impact on quality of life, yet new and effective pharmacological and non-pharmacological treatment options have only recently emerged. The article by Tack and colleagues in the current issue of NGM is timely with the recent introduction of the serotonin type 4 receptor agonist prucalopride in Europe and wider acceptance of anorectal biofeedback for patients with pelvic floor dyssynergia. This Editorial (i) highlights the importance of identifying patients with pelvic floor dysfunction who are candidates for pelvic floor retraining programs and (ii) discusses the potential limitations of the 5-HT4 agonist, prucalopride, as an early option in the treatment algorithm for CC.