Constipation with IBS
In a patient with constipation-predominant IBS, we will attempt a high fiber diet, starting with small amounts and increasing gradually. Wheat bran, at doses of 10 to 30 g, is the best known and perhaps the most effective fiber supplement but commercial products may be more acceptable to some patients.
Abdominal pain and bloating occur with fiber supplements in many IBS patients. PEG may be substituted in patients who do not tolerate fiber supplements, but we minimize the use of stimulant laxatives. Tegaserod may be useful in women with constipation-predominant IBS, although the cost of the drug far exceeds other available agents.
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