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Answer 3
  1. Psyllium fiber supplementation. Psyllium fiber supplementation is the best first-line option. Amitriptyline may minimize visceral hypersensitivity, a symptom that patients with IBS may have. Hyoscyamine can function as an antispasmodic and can be taken either as a scheduled daily dose or on an as-needed basis for focal episodes of pain. Psyllium fiber supplementation is first-line therapy for patients with constipation-predominant IBS. Fiber is safe, inexpensive, available without a prescription, and highly effective. Fiber traps water in the intestine, thus softening the stool and improving constipation. Fiber also helps promote bowel regularity. Although acetaminophen may be of some value for pain, the addition of a narcotic to the formulation would only slow bowel transit and likely worsen this patient’s constipation.

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