There are limitations to this study. Although self-report of dietary intake is a common and practical method in clinical studies and validity and reliability improve with training and review, findings of usual fiber intake must be considered estimates compared to laboratory analysis of intake or providing a controlled diet in a metabolic unit. The scales to report symptoms and emotional upset lacked testing of validity and reliability. Generalizability of results is limited because subjects have fecal incontinence, and their symptoms in response to a dietary fiber supplement may not be the same as those of individuals with a normal bowel pattern.