The World Gastroenterology Organisation (WGO) has released its 2025 guideline on the diagnosis and management of chronic constipation, introducing a 'Global Cascade Approach' designed to provide adaptable, resource-sensitive recommendations for healthcare professionals worldwide. The guideline, which focuses on adults, provides a tiered framework that acknowledges the significant global variations in healthcare resources, sociocultural factors, and disease epidemiology, making a single, universal "gold-standard" impractical. The guidelines aim to support clinical decision-making from primary care to specialized gastroenterology, ensuring appropriate care across diverse settings. Chronic constipationis a common gastrointestinal disorder marked byinfrequent bowel movements, typically fewer than three per week, and symptoms such asstrainingorhard stools, and a persistent feeling ofincomplete evacuation. It affects an estimated9% to 20% of the global population, with a higher prevalence amongwomenandolder adults. The new WGO guideline offers a structured, hierarchical set of diagnostic, therapeutic, and management options, ranked according to available resources, to address this widespread issue. It delineates three distinct levels of intervention for the treatment of general chronic constipation, progressing from basic, widely available options to advanced therapies requiring extensive resources. Key highlights from the guideline include: This level focuses on easily implementable and widely accessible interventions: When first-line strategies fail, this level introduces more specialized treatments: Applied in settings with extensive resources, this level includes advanced medications, device-based therapies, and surgical options for patients unresponsive to lower-tier treatments: Vibrating Capsule: A swallowable device delivering vibratory stimulation to improve complete spontaneous bowel movements (CSBMs). Percutaneous (or transcutaneous) tibial nerve stimulation (PTNS/TTNS): Targets sacral nerves regulating colonic motility; useful in specialized or research settings due to protocol variability. Sacral nerve stimulation (SNS): Though used for fecal incontinence, lacks consistent efficacy for constipation and is not recommended outside clinical trials due to risks and costs. Repetitive transcranial magnetic stimulation (rTMS): Still experimental, but early studies show potential benefits in bowel frequency and symptom relief. The WGO guidelines also provide a specific cascade approach for patients with chronic constipation specifically linked to a defecatory disorder. This new WGO Global Cascade Approach offers a comprehensive and adaptable framework, aiming to standardize and improve the diagnosis and management of chronic constipation across the diverse healthcare landscapes of the world. Reference:https://www.worldgastroenterology.org/guidelines/constipation