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Chronic constipation is classified as isolated obstructed defaecation (OD), isolated slow transit constipation (STC) or both (OD + STC). Interest in surgery for STC has waned while that for surgery for OD has expanded. We aimed to determine the incidence of isolated STC in chronic constipation and to study symptom pattern in those with delayed colonic transit.Patients underwent defaecatingproctography, colonic transit study and classification: (1) isolated OD (outlet obstruction and normal transit); (2) isolated STC (no or insignificant outlet obstruction + delayed transit), (3) OD + STC or (4) normal. Symptom patterns were defined: STCtype = twice weekly stools or less, OD-type = more than twice weekly stools.Of 541 patients, 289 had isolated OD, 26 (5%) isolated STC, 159 OD + STC (3), and 67 (12%) normal. Of 448 patients (83%) with OD, 35% had additional STC. Fourteen percent of delayed colonic transit was isolated STC. OD rather than STC-type symptom pattern was more common in all three groups, (isolated OD 86%, isolated STC 54%, OD+STC 63%).Most patients with chronic constipation have OD, most STC is associated with OD and is unusually isolated. These data question the clinical significance of isolated STC. Patients with STC with or without OD typically complain of OD rather than STC-type symptoms.