Table 1.
A stepwise approach to management of bowel dysfunction
| Intervention | Mechanism | Indication |
|---|---|---|
|
Fiber (soluble or psyllium) |
Stool binding | Stool frequency |
|
Bile acid sequestrants (cholestyramine, colesevelam) |
Stool binding | Stool frequency |
|
Anti-diarrheals (diphenoxylate/atropine, imodium) |
Slow GI motility | Stool frequency and clustering |
|
5-HT3 antagonists (ramosetron) |
Slow GI motility | Stool frequency and clustering |
| Biofeedback therapy | Neuromodulation | Stool frequency and fecal incontinence |
|
Acetaminophen with low dose codeine (use sparingly) |
Slow GI motility | Refractory fecal incontinence, stool clustering, and frequency |