Pharmacological management may include anti-diarrheal/constipating agents and laxatives/stool bulking agents. Bulking fibers can be soluble (e.g. psyllium) or insoluble (e.g. cellulose and hemicellulose). Starch is used as a bulking agent. For instance, psyllium provides bulking as well as viscosity. Most bulking fibers are not fermented or are minimally fermented throughout the intestinal tract. The bulking phase entails remaining in a net positive energy balance (calorie surplus). For instance, cellulose and wheat bran provide excellent bulking effects, but are minimally fermented. It is used in foods as a bulking agent, stabilizer and a thickener. Dietary fibers make three primary contributions&colon; bulking, viscosity and fermentation. Some types of insoluble fiber have bulking action and are not fermented. It is sometimes treated with urethral bulking injections. Fumed silica is used as a bulking agent for thicker coatings of the material. Bulking agents also absorb water, so may be helpful for those with diarrhea. Bulking material also covers feces and reduces insect access. Their body becomes more deep set toward the abdomen, which area also starts bulking out.