For patients with IBS and constipation, the addition of supplemental fiber may help to normalize bowel movements and alleviate related symptoms, such as tenesmus, dyschezia, and abdominal pain. There are numerous fiber supplements available over the counter; the decision regarding which one to choose depends primarily on the patient's preference (ie, liquid, capsule, or wafer). It is important to instruct the patient to consume adequate amounts of water with the fiber to avoid potential side effects. If additional therapy is required, osmotic laxatives can be used safely and indefinitely. These include nonabsorbable carbohydrates (lactulose and sorbitol), milk of magnesia, magnesium citrate, or a polyethylene glycol solution (Miralax) (Table 39-3). There is a separate chapter on constipation.


A more global approach to patients with the IBS and constipation utilizes the 5-HT4 agonist tegaserod (Zelnorm). Tegaserod is approved for the treatment of women with IBS whose primary bowel symptom is constipation. In well-designed trials, tegaserod has been shown to accelerate colon and small intestine transit, increase the frequency of bowel movements, increase the softness of stools, decrease abdominal pain, reduce bloating, and improve patients overall satisfaction with bowel habits (Muller-Lissner et al, 2001). Diarrhea and headache are the most common adverse events associated with the use of tegaserod (affecting 9 and 15% of patients, respectively). Ischemic colitis and electrocardiogram changes have not been seen with the use of tegaserod. The recommended dose is 6 mg orally twice daily before breakfast and dinner. This agent is also used in smaller doses to enhance gastric emptying as discussed in the chapters on gastroparesis (Chapter 31,"Gastroparesis") and on nonulcer dysphagia (Chapter 30, The Management of Nonulcer Dypepsia").

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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