Many patients who are receiving opiates develop a problem with constipation. Constipation can be prevented in most patients who are receiving narcotics by judicious and routine use of laxatives contributing to the comfort of the patients. In general the responsibility for bowel management is delegated to the nursing staff, but joint responsibility between the nursing and medical staff is recommended. The author defines constipation, highlights its incidence, and gives a short overview of its numerous causes, including the effects of narcotics on the gut. He suggests a protocol for bowel management, lists the different types of laxatives, and discusses rectal measures, such as suppositories, enemas, and manual disimpaction. A stepladder approach, which has proven to be effective and simple, is outlined.