Curbside Consultation of the Colon: 49 Clinical Questions

Brooks D. Cash, MD, FACP, CDR, MC, USN

Question 16: How Efficacious Are The Therapies For Chronic Constipation? I Have Heard About Several New Drugs For Constipation—Have They Been Shown To Be Cost Effective? (continued)

Erica Roberson, MD; Arnold Wald, MD

The first choice of many patients for constipation is often fiber supplements (bulking agents), which are readily available in some foods or as over-the-counter preparations. Although a deficiency of dietary fiber uncommonly causes constipation, some individuals do respond to an increase in fiber to 20 to 30 g daily. Fiber has been shown to increase stool weight and decrease transit time through the gastrointestinal tract. Soluble fibers such as psyllium may be better tolerated than insoluble fibers, but this is highly variable. Patients should be told that immediate results are not to be…