A NOTE FOR WOMEN AND TEENAGERS

The feedback I get from most women is that their (male) doctors are dismissive and incredulous about the woman's constipation issues. Doctors are going to act like you are crazy and hormonal. They're going to tell you to just eat some fiber and take some miralax and bugger off. You have to be strong, confident, and knowledgeable of your situation. Do not take no for an answer. Inform your doctor that you are past the standard constipation treatments and this is an ongoing problem that reduces your quality of life and warrants the attention of a specialist.

It helps if you appear to know what you are talking about. Learn about your digestive anatomy and understand the difference between your small and large intestine. Understand the constituent parts of the large intestine (ascending, descending, sigmoid, transverse, rectum, etc). This will help you communicate to your doctor more efficiently and it will help you better understand his/her findings. If you show your doctor you've done your homework, it is very likely he/she will take you more seriously.

I strongly recommend bringing a man to your appointment with you, because doctors can be sexist and dismissive toward women. Instruct the man attending to pressure the doctor to address your questions and requests, and to repeat your questions to the doctor if he ignores them.

Everything I just said applies to teenagers. The additional problem facing you is that you have an extra gatekeeper: your parents, and the fact that you rely on their insurance. You need to have a level-headed conversation with them about your situation, however embarrassing that may be, and convince them that they need to be advocates for you, not obstacles to you. Getting them on your side now will benefit you greatly when the doctor questions the seriousness of your complaint.

Context: Suffered from chronic constipation for about 15 years. All 26 feet of intestinal tract were almost always completely clogged. Ridiculous handicap in the game of life.

On this particular day about two months ago, I did not set out trying to fix my constipation. Rather, I was trying to quit caffeine for the millionth time, and I was doing things to try to give myself more natural energy.

I owned a juicer, and I knew that juicing certain vegetables, especially cucumber/carrot/celery, made me feel good and gave me a bit of energy.

One day, I juiced first thing in the morning, and I felt even better after drinking the juice than I usually did. I almost didn't feel lethargic due to the lack of caffeine (almost).

So, I Googled "vegetable juice empty stomach reddit" to see what was going on.

All of the posts were from a subreddit called "Medical Medium", which I had never heard of. All of these people were freaking out about celery juice in particular on an empty stomach first thing in the morning. I already did a partial celery juice, so I decided to try pure celery juice out of curiosity.

Celery juice alone, without cucumber and carrot, definitely had a better effect on my energy levels than the mixture did. It also had a more noticeable effect on my digestion. In fact I had a couple days in a row where I had a decent BM in the morning, which was unheard of.

Out of curiosity, I took about five seconds to look into whatever the hell "Medical Medium" was, and saw it was essentially some recommendations from some random dude. Fine. He had some books, but I was nowhere near that level of commitment, so I Googled "what do you eat in a day medical medium reddit".

I basically ascertained that a lot of these people started with lemon water, then did the celery juice, then did something called a heavy metal detox smoothie. I already was a fan of lemon water, so I added that in. I also started doing the heavy metal detox smoothie, which was a pretty standard smoothie just with weird ingredients added in like cilantro. Again, I was only doing these things because I got the celery juice recommendation from the same source and it worked.

My morning bowel movements became even better. Before, I literally wouldn't go #2 for 4-5 days in a row, frequently. My chronic constipation was always between moderate and severe. Now, I was not only going every day, but I was going a lot. Within a few days, I felt like my intestines were completely free and clear. It was genuinely the most amazing thing in the world.

I kept looking into this Medical Medium thing and saw this dude made a couple other core recommendations. One, he claimed you shouldn't eat fat early in the day. He also recommended to eat as many fruits and veggies as possible throughout the day, because if your body needs to heal from something, it's best to stick to nutrient-packed foods that are easy to digest.

Neither of these claims were outrageous to me. In the past, I had already done something called "fruit only before noon" and I had felt much better than I did eating your standard bread/eggs/cheese/etc. for breakfast, so that tracked. And in the past, I had also gone vegan, and I felt much smarter and emotionally sound while doing it. My digestion had also massively improved. Unfortunately I hadn't been able to keep to a vegan diet forever. About a year in, I started feeling pretty miserable.

So, I decided to take one more step up. I kept up the lemon water, celery juice, and heavy metal detox smoothie. Then, I ate tons of fruits and vegetables, mostly just fruit, leafy greens, and cucumbers, until dinnertime. At dinnertime, I had a large meal that had animal products. Most of the time, it was corn quesadillas with cheese, a small amount of chicken, and some vegetables. If I got hungry before bed, I would eat a lot of fruit and/or vegetables. Usually apple with honey.

I thought my digestive tract was clear before --- it wasn't. The effects of this diet were monumentally amazing. For the first week, I was sh*tting so much, and so frequently throughout the day, that I could not believe how much was coming out of me. My BMs made me feel genuinely euphoric, which is weird, but the literal physical effect of finally cleaning out my intestines elicited a physical response of euphoria, no joke. Now...

My digestion is perfect.

My skin is flawless. (Had moderate to severe acne to accompany the constipation, fun stuff.)

I have tons of energy. (I do not need caffeine.)

My mental state is so much better. (The nebulous malaise that stems from chronic constipation is awful.)

So, that's my story. I actually have almost completely cut out animal products and replaced my dinner with tons of steamed potatoes and various vegetables. I'm all fruits and vegetables. Though I will still eat fish or avocado if I feel very hungry for some reason. My digestive tract has been clearing out years of buildup stuck to the walls and all sorts of other disgusting stuff that results from chronic constipation. Can't believe I'm free and clear, finally.

If my story interested you, you don't have to put faith in me. I'd start with just the lemon water and celery juice.

The lemon water is extremely easy --- you should already be starting your day with water, so squeezing a lemon into it isn't a big deal. I personally only drink lemon water throughout the day now.

For celery juice, you will need to buy a juicer. I personally have the JC3000RD13 from Omega which is $100 and works great. You can also search Facebook Marketplace for very cheap juicers because many people buy them and get lazy and try to sell them.

If you don't want to buy a juicer, I'd say starting your day with no fat, not even a little bit in the form of almond milk or something, is the next most important thing for digestion. For example, eating lots of fruit in the morning and trying to get in a salad with no fat before your first meal with fat.

Hope this helps someone, see you on the other side my constipated friends.

I wanted to make a post about how to treat STC, because I have never seen a comprehensive regimen for treating it anywhere else on the internet, and even the gastroenterologists I've seen have struggled with treatments.

Since my diagnosis I have experimented a great deal with drug combinations (under the careful supervision of a specialist, mind you), and I've developed a routine that works so well my life is basically normal again. This regimen has about a 95% success rate for me; it's far better than any other regimen I've tried.

As with all of my advice, take it in consideration with your gastroenterologist; don't do anything without consulting him/her. The two prescription medications I recommend here are safe when taken together, but many other combinations of drugs that include them are NOT safe, so don't fuck around with drug mixing. These medications are also very expensive and require a specialty prescription to obtain. They are unavailable in some countries, especially prucalopride, which is brand new.

Diet: lots of watery fruits, vegetables, chicken and beef. NO gluten, NO milk, very little cheese. Enormous amounts of water, like twelve glasses a day. Bread products are the worst for my digestion and basically turn into cement in my intestines; cheese is almost as bad. Other grains like sweet potato, white potato, and rice are easier to digest and don't appear to harden in the same way. For some reason, breakfast cereals, chips, and granola are also very difficult to digest even if they're gluten free. I think it has something to do with them being dehydrated / processed.

Exercise: Jog every morning, walk every night. Jump rope and pushups whenever I have the energy. Hiking semi-regularly.

Medications:

• 2mg prucalopride (daily - but rarely works by itself on the days without linaclotide)

• 70mcg [that's micrograms] linaclotide (every other day)

• senna tea (once weekly)

• bisacodyl (once monthly)

Regimen:

Day 1: Upon waking up, take the prucalopride and linaclotide on an empty stomach. Drink 2 glasses of water. Go on a 40-minute jog or a 1-hour walk. Upon return from walk, drink more water. Do not eat any food or drink anything but water. BMs begin about 2.5 hours after taking the medication. An hour after BMs begin, eat 1 apple, 1 banana, 1 handful of mixed nuts, and a daily vitamin, and occasionally a mineral packet in water.

Day 2: This is an off-day. I take only the prucalopride, which isn't super effective by itself, but occasionally causes a BM. I eat breakfast whenever I want and jog or walk if I feel like it.

Rinse and repeat day 1 and 2, except sometimes I'll take senna tea right before bed on the off day, and skip the linaclotide (but still take the prucalopride) the next morning on the on day. The purpose of this is to give my intestines a break from the linaclotide, which I believe (without evidence) is not good for the intestines to take on a regular basis.

Once a month I'll swap the senna for bisacodyl, just to prevent my body from building up any sort of tolerance to either of these. They're stimulant laxatives so they have diminishing returns over time if used too frequently. See my comment for more information on the debate over whether stimulant laxatives are dangerous, and also read what I've written on bisacodyl and senna in this medication guide.

I can honestly say I went through something (and am still going through it) that was one of the worst things to ever happen to me. I am a 52 year old male. I have had constipation issues for many years which doctors have told me over and over again to eat more fiber and drink more water. Still, I would get constipated fairly regularly. I did not see it as a big deal and learned to live with the occasional stomach pain and straining when i went to the bathroom. Before what happened this time, twice in the last ten years when tried to poop, some really hard stool would get stuck in my anus and I would not be able to pass it for hours. It was definitely very uncomfortable and nerve racking but both times I eventually pushed it out and all was fine. One week ago today I woke up and felt like I had to go. I had not had a bowel movement for 5 days and had been very constipated before that. I had recently changed my diet to limit carbs and cut out all bad foods and felt the constipation was an obvious result of the dietary change. I had way more cheese than usually in the week leading up to this. That said, I had been feeling so good and losing weight with the dietary change that I blew off the constipation and didn't give it a second thought. Well, a week ago I woke up to go and stool pushed into my anus but this time it was like cement. There was nothing I could do to push it out. I took milk of magnesia and laxatives. I put on a glove and tried to get some out with my finger but I could not get the poop to move. I suffered at home from 11am until about 8pm when I decided I needed to go to the ER. I could also not urinate because of the stool pressure.

When I got to the ER I was in severe distress. My pulse and blood pressure was through the roof. I could not sit down and had to wait about 75 minutes until I was brought in. I was taken for a quick x-ray and then to a room in the ER where the doctor told me they needed to remove the impaction using her finger to loosen it followed by enemas. I had been in agony for 11 hours at this point but what came next was like being tortured. She inserted her finger (or fingers, I'm not sure) into my rectum while I was laying on my right side. This was one of the most painful and uncomfortable feelings I have ever experienced. I was screaming in pain. Screaming. The pain was in my rectum which she said was from an inflamed internal hemorrhoid but also I felt immense pain in my penis, as if I was being given the roughest, most intense prostate exam I ever had. After she did that for about 15 seconds they inserted an enema and some of the stool she had broken up began to come out. She repeated finger insertion/enema two or three more times, each time being even more painful and severely uncomfortable, until the stool was out of my rectum. There was blood too from the inflamed hemorrhoid. After settling down for a bit I was given a CT scan that showed much more stool in my colon as well as a thickening of the rectal wall which they said was indicative of proctitis. (Proctitis can be caused by unsafe anal sex practices but I am I straight male so that's not what caused it) I ended up staying in a ER room for almost 24 hours where I was given stool softeners and a catheter to get the urine out of my bladder. I was given 2 different IV drip antibiotics. Once the catheter was removed I needed to show i could urinate on my own before I was discharged or else they would have had to keep the catheter in. I was able to urinate enough to finally be allowed to go home.

I was prescribed more antibiotics as well as some suppositories which I began taking the following morning. I have a follow up appointment with the colorectal surgeon which is in 2 weeks. Since the swelling and pain have gone down a bit I have noticed that nothing feels the same. Getting poop out my body feels incredibly difficult as if my rectum is no longer working correctly, and I am taking stool softeners. The antibiotics cause diarrhea so everything has been pretty much liquid coming out but I constantly feel like I need to go. Also, it looks and feels as though my anus has been stretched out or torn and does not close like it did. This makes it feel like every time I sit on the toilet poop will start to come out. The other problem i am having is that I cannot get an erection and my penis feels completely different, as if some internal damage has occurred. I'm greatly concerned about this. I think maybe the injury to my anus has cause nerve damage that relates to my penis. My penis looks the most flaccid I have ever seen it. Almost like a dried prune. It looks much smaller when flaccid. The sensation on it's skin it very dulled. It does not look or feel like my penis did before this happened.

So everything happened exactly one week ago today. I have been extremely agitated, angry, depressed since Saturday. Trouble sleeping and feeling like life as I knew it is over. On July 4th I think I had a full blown panic attack. Shortness or breath, numbness in my left arm and just feeling awful. It could have also been a reaction to the antibiotics which are very strong. I almost went back to the hospital but after about 30 minutes it passed. I have not been able to work or experience joy in things i would normally love to do. I am really hurting both physically and emotionally. I'm in hell. I messaged my primary care doctor (she does not have an open appointment until august 18th) to see if I could get a urology referral and waiting to hear back. I did not tell her about my emotional state.

I'm sharing this to hopefully gain some insight from anyone who has been through something similar but maybe just to tell someone else as like a form of therapy. Or maybe there are some doctors lurking here who can provide insight. I'm really hurting and in a dark place. I have been in bad places before and know this is temporary but while I'm here it feels as though this is the new norm for me and I'll never be able to be happy again. I hope that is not the case. Thanks for reading and thanks for letting me share.

(My Questions for You answers are: 1) Yes. Before this happened yes. 2) Just constipation before this. 3) No 4) probably began early adulthood 5) No 6) No)

A lot of people who are diagnosed with IBS C or chronic constipation, especially if they aren’t responsive to diet and lifestyle changes, often end up having one or more significant motility disorders.

Many different things can cause these.

When you have chronic constipation, there is an order of operations you/your doc should follow.

• first try dietary and lifestyle changes (ALL of them); if that doesn't work...

• then try over-the-counter medications and supplements. If those don't work...

• then you need motility testing done. Depending on your results of them...

• then you go to prescription medication. Try them in different combinations and try all of them. If those fail, as well...

• depending on your diagnosis after your motility testing, you may be eligible for non-invasive and invasive treatments to treat it. If those don't work…

• again, depending on your diagnosis, then surgery is an option

If you are seeing a gastroenterologist and this isn’t laid out for you, chances their specialty isn’t motility. Unfortunately, many people get sent to GIs who have a speciality in something other than what they need. For motility, you need to see a motility specialist or a neurogastroenterologist.

There is a PSA I wrote and it is stickied above. I’ve been living with this since I was born (over 40 years). I also have worked in this area, as well. I try to spread awareness and this is often falling off of the radar and patients are just told to eat fibre.

With motility disorders, fibre is often the menace.

Testing for motility includes, but is not limited to:

• esophageal manometry

• antroduodenal manometry

• gastric emptying study

• 72 hour emptying study

• upper gi series barium swallow

• there was a wireless motility capsule but it’s been discontinued. There are a couple new ones in trials. Don’t hold your breath.

• sitz marker test (also called a shape study)

• colonic manometry (very key test but hard to get)

• anorectal manometry

• defecogram (mri or xray)

If you have any questions on testing, treatment, where to go, and so on, let me know.

So yeah, I had many years of constipation, often persisting for a few weeks, then resolving again, then it happened again, and since the end of October I was pretty much constantly constipated. Nothing helped, because no stool entered the colon. Gastros over the years just shrugged and didn't investigate.

Last week I had a supracervical hysterectomy. And guess what: I had a bowel movement some 30hrs after surgery, and since then many more. It just works again. I have no idea whether that blasted organ and it's dozens of tiny myomas pressed onto a part of my intestine or whether something else happened but I'm happy.

Hi everybody, I figured this sub might be interested in the fact that I am now participating in a study for the Vibrant Capsule. This is a non-drug capsule with some kind of mechanism inside that vibrates, which stimulates peristaltic contractions in the small and large intestines.

Images of the system

My gastroenterologist put me in the study, and I took the first pill yesterday. It costs $89 US without insurance (my insurance won't cover it until after the trial is over), and you get 20 pills per month (that's 5 pills per week with two days off, staggered between three and two on-days).

A large study showed improvement among 70% of participants; they had 1 to 2 more SBMs per week compared to baseline. No participants dropped out, and no one experienced serious side effects.

The data shows most people begin experiencing SBMs between 1 and 2 weeks after beginning treatment.

My log:

Week 1:

The pill was as big as a large vitamin. A little hard to swallow for me, but no big deal. Very slight headache a few hours later; not sure if it's from the pill or just being tired. No SBM yet.

Week 2:

I can feel the pill vibrating! It's funny. Doesn't cause pain and just feels like mild gut rumbling. I've felt it three times now, always in the same place: an inch below my belly button, and to the right about 3 inches. My wife is able to feel it too if she presses her hand there.

Maybe a small amount of success with SMBs but not sure. Still using intervention meds every few days. No side effects to report. Treatment is well-tolerated

Weeks 3 and 4:

Unfortunately I dropped out of the study. The treatment has no effectiveness for me.

Helpful advice from a Nurse about dealing with constipation/chronic impaction

Just some helpful advice from a nurse.

Constipation is terrible. It’s horrible and 99.9 percent of the time it doesn’t need an ER visit. It is cruel, it is uncomfortable and quite literally feels like giving birth through a whole you are not prepared for. Some helpful things to have on hand are stool softeners, enema squeeze bottle, enema bag and solution, miralax, and citrusil.

If your stool is too large to pass, you will eventually pass it. It will be uncomfortable, there might be some ripping, and bleeding. Bright red blood , not in stool is typically caused by hemorrhoids (internal or external) anal fissures, or slight tearing. If you are passing dark red blood, and dark red blood in your stools please see a doctor as this is indicative of higher internal/GI bleeding.

If you are already impacted/constipated please do not take bulking fiber. Fiber is great and all but when you’re constipated you do not want to bulk up your hard dehydrated stool. Speaking from advice, if you’re constipated/having trouble going. Take a lot of stool softeners, an example being docusate sodium. You cannot overdose on stool softeners, but you can get very dehydrated so make sure you drink a lot of water.

Another complaint I hear a lot on this sub, is the mass feels too big to pass. If it’s small pellets stuck together it can be helpful to wear a glove and attempt to break off pellets to allow some smoother passing. While taking stool softeners, if you have a full blockage and are taking a lot of stool softeners be prepared for some leakage as the diarrhea and the watery stool go around the blockage which will help lubricate the large stool to pass. It’ll hurt, but itll pass.

ENEMAS. They have the squirt bottle enemas, but I’ve heard that those aren’t as helpful as the bag version. Make sure you lay on your left side with your leg bent as it relaxes your colon. If it’s a first make sure you instill the liquid slowly, if you feel cramping you can lower the bag a little, if that doesn’t help you can clamp the solution and then continue. Try to instill at a slow and stead rate, and continue. Make sure the solution is warm to the touch, similarly to bath water.

If you have any questions my DMs are open, whether it be for shitting advice, or any questions that you’d feel comfortable /or even uncomfortable asking your nurse about. I feel like sometimes we withhold information due to embarrassment... but I’m here for yaal !

[Update] 90 days later - I'm cured! See updates at end of post.

Hi all, thought I might share this success story of how I beat constipation.

I've had terrible constipation my entire life, and mainly for the past 4 months, only going once every 4 to 5 days, always very dry and rock-like. I was so constipated that my belly was usually swollen, hurting, and pressing on my backbone. Sleep was difficult. It also didn't help that I wasn't sleeping more than 2 to 3 hours a night due to an injury. I was willing to try anything to get my health and sanity back.

Now I have one perfectly healthy bowel movement every morning like clockwork. It's absolute magic, I can feel myself getting healthier every day.

How did I do it?

I talked to a health practitioner who has treated thousands of patients. He knows that works, and what doesn't, based on dealing with a lot of sick people. He recommended the following, and it worked absolutely brilliantly.

The most amazing thing is that it worked from day 1. It was absolutely incredible. When I stopped point #4, everything continued on like a normal person.

1. Drink 2L to 2.4L of water per day

• Sip it slowly throughout the entire day. This means that the kidneys can keep up. Gulping 1.5L at once will overload the kidneys and lead to water retention. Divide that 2.4L into equal chunks so you get through 1L prior to 11am, and the rest prior to bedtime.

• Myth (sprinkled all over the internet!): don't drink any water 30 minutes prior to a meal, and 1 hour after. Reality: the stomach has a very ingeneous arrangement where small amounts of water flow under the bolus of food straight into the small intestine. It's okay to sip small amounts of water, it won't affect digestion much.

2. Magnesium Citrate

Start with a 1400mg pill providing ~400mg of elemental magnesium prior to bed. This is the RDA, its perfectly safe. If things are not working, increase to 800mg elemental, some people even go up to 1200mg elemental which is 3x RDA, and perfectly safe. Find the level that works for you. At this level, it's above RDA but these levels can be sustained indefinitely. As the bowel gets going, could reduce.

• Myth (everywhere on the internet). Magnesium citrate is an osmotic laxative, it will cause water retention. Reality: it doesn't, quite the opposite.

• Myth (everywhere on the internet). Magnesium citrate can cause dependency. Reality: it doesn't. Once the bowel is moving again, can titrate down.

3. Probiotics

Kimchi or sauerkraut with every meal, or a good probiotic.

Update: another Reddit user recommended a fix, this adaption works for me: 5 tablespoons of chia seeds, 5 tablespoons of Kefir in 1.5 cups of water. Soak overnight in fridge. There should be sufficient water so that the chia seeds are fully soaked; there should be a little bit of free water on top. Drink 1 cup of this per day. This acts as a fantastic prebiotic, and helps with constipation as it gives bulk to the stool.

4. Coffee

As described at https://www.trulyheal.com/why-coffee-enemas-are-truly-magical/ and Coffee Enema Recipe and Instructions. Some myths that needing busting before I would even try this:

• Myth: this is not conventional medicine, therefore it is pseudoscience. Reality: This technique has been successfully used for a very long time in many cultures. It's only western medicine that started frowning at the very idea, presumably as they can't sell more drugs if people are treating themselves.

• Myth: it's not Paleo. Our ancestors didn't do it, so we shouldn't either. Reality: out ancestors did a lot of other things that prevented constipation. We are not our ancestors.

• Myth: it's too gross to even think about. Why would you go there? Reality: I was willing to try anything to fix my constipation. I was in pain and my health was failing. This worked for me.

• Myth (sprinkled over the internet, not hard to find!). It's not safe to use continuously, it "creates dependency" and "dries the bowel out" and and "it's dangerous". Reality: it is safe; the bowel is very robust, you can use it continuously for 6 months and when you stop everything will carry on as normal. If you don't believe me, talk to a health practitioner who has worked with thousands of patients and get their opinion.

• Myth (pushed aggressively by the Google filter bubble). Some people have had a perforated bowel. Therefore, all enemas should be discouraged under all circumstances. Reality: The bowel is very robust, it's absolutely safe. The only examples in the literature are a few case studies of very old people with a thin bowel wall, usually with some sort of dementia with everything that implies.

• Hint: If the liquid is held in for about 10 minutes, you will hear a gurgle in your liver. That's the liver expelling bile. Hold until 15 minutes then you're done. I didn't believe it when I heard it, but it happened just as the practitioner said it would. If it doesn't, up your magnesium slightly, take magnesium on an empty stomach the night before, increase coffee up to 3 level tablespoons, water up to 900ml.

• Hint: use coffee specially designed for enemas. Light roast, etc. Make sure it's cooled down to skin temperature.

• Hint: when brewing the coffee, the grounds won't dissolve. Have to strain them out. It's not instant coffee like Nescafe.

What else did I try?

Everything. All kinds of commercial laxatives, some of them led to water retention which is not nice as tissues swell up (beware of any laxative that is in the class of osmotic laxative). Copious amounts of water. Magnesium (didn't work by itself). Bowel self massage. Watched tons of YouTube videos. Castor oil. Running. The thing that actually worked in practice was intervention #4.

I also tried many of the off-the-shelf suppositories with absolutely no success. The glycerol ones didn't work at all, and they gave me terrible water retention so my feet and hands swelled up painfully. I could barely walk. Miralax gave temporary relief while I was using them, but as soon as I stopped the issue came back. They never appeared to fix the underlying cause of the issue like intervention #4 did. Its almost like all of the commercial pharmaceutical suppositories and pills are designed to cover the symptoms, rather than fix the root cause like intervention #4 appeared to do. See latest update at base of post.

Summary

Anyways, hope this is useful to someone. It certainly relieved my suffering, and it was only the occasional 20 minutes of my time to get things moving again.

Wish I had known this 4 months ago.

Update

Update 9 days later. I stopped intervention #4 for a week, and still had perfectly healthy stools every single day. My gut is now the healthiest its been in 5 years. Its like something just got fixed in my gut and its working nicely now, and all I need is interventions #1, #2, #3.

Update

Second opinion from another health practitioner. Apparently, Magnesium Citrate is great but it has one potential downside with long-term use: it alkalines the gut. A slightly alkaline gut can result in fungal issues, e.g. candida. The gut should be slightly acidic to prevent this. I did notice that if I took the occasional teaspoon of organic Black Seed oil that I felt a lot better, which indicates some sort of gut dysbiosis. Another approach is to use vitamin C, look up "ascorbate flush". I havn't tried this.

Update day 15

Given that my constipation might have been caused by some sort of gut dysbiosis (e.g. candida or SIBO), am doing a stool test "CP+P Culture PCR + Parasitology": https://regeneruslabs.com/products/comprehensive-parasitology-x3-cp3. Based on these results, can decide what to do if there is any imbalance of flora.

Update day 21

After 21 days, my constipation is now mostly a memory of the last 10 years.

Havn't sent my PCR test off yet.

Updated section "3. Probiotics".

Update day 40

Everything still working perfectly. Am doing #4 above every week or two. It took 10 days of doing it every day to let everything heal, after that I was fine.

Update day 90

I could consider myself to be cured. No issues whatsoever, and I don't need to do anything. No coffee enemas, no magnesium, no focus on water, no need for probiotics - I'm healthy. This is the best I've been in 15 years.

I just wanted to share what’s been working for me while taking Linzess. I’ve been taking it about 2 months now. I am on the max dose which I think it’s 290mg. I don’t know what my exact issue is, the Gastro just gave it to me without any testing, but it’s been great. Personally I just feel like my body isn’t absorbing enough water or something. I drink a lot of water but it really doesn’t seem to do anything at all. What I do is taking Linzess on an empty stomach when I wake up (6:30am). I then try to drink one Nalgene (32oz) before I get to work (7am) and another after I get to work (7-9am). I then just hold my pee. I hold it until I no longer can and I feel like I’m gonna wet my pants if I wait anymore, and every time I will then have to poop. I don’t know if maybe I’m just giving my body more time to absorb water, or giving Linzess time to absorb water, or if it’s my full bladder pushing on my guts? I don’t know why it works but it has been extremely reliable for me. Usually take Linzess around 6:30am and will be pooping around 9:30am.

The most common off the shelf laxative enema is the Fleet Saline Enema. First I will say that they do work, they’re magically effective, but do not use them frequently!

First, saline makes you think of saltwater (sodium chloride and water). That is NOT what this in this. Its active ingredients are two forms of sodium phosphate, which are serious stimulant laxatives on the level of bisacoydl, and has the same dangers.

I used them about every other day for nearly a month when I had swollen hemorrhoids that made it really hard to pass stool naturally, after my doctor said it was no big deal to use them frequently while the hemorrhoids go down.

I trusted him even though the box says don’t use more than 3 days in a row. But after getting off of them I completely lost bowel motility, my colon just stopped moving stool, I also lost the urge to poop.

Is very scary and miserable to feel your guts filling up each day but getting no urge to evacuate. It’s called “lazy bowel” where the laxative abuse can cause the colon to lose sensation and normal tone and nerve response, and can no longer contract to evacuate stool normally.

It was terrifying to read that using stimulant laxatives orally or enema can sometimes to cause this to be irreversible if used too long.

Fortunately after nearly a week things are stabilizing and I’m feeling super grateful. I was able to go partially yesterday and more today. Wanted to share the experience with others so they don’t have to go through this. Stay safe y’all

I'm 37 years old and I've been suffering with IBS-C (no urge to go) since I was about 20. Basically I'll have no movement for 3-7 days or so and then (after worsening symptoms including bloating, distension, abdominal pain, reflux, poor appetite, fatigue, disrupted sleep) I will finally have a movement (or several), to be followed by a resumption of no movements and worsening symptoms.

I've been working my way through every suggestion in this subreddit and my symptoms have improved a bit (mostly due to avoiding grains, cycling through various stimulant laxatives, and following a strict morning routine exercise+meal+coffee). I now find myself having one bowel movement pretty much every day (yay!), but the size and (feeling of) completeness varies. Some days small, some days medium-large. Occasionally I'll lay a massive toilet-clogging log. The bigger the poop, the better I feel, but I still suffer with all of the aforementioned symptoms (particularly bloating/distension). It's overall less severe compared to when I was not pooping for days on end though, for which I am thankful.

So this got me to thinking, how much of my bowel is actually being cleared when I poop?

Well it turns out not much. I am completely full of shit...ALWAYS. I'm not even coming close to clearing my bowels, even following the very biggest/best of bowel movements.

I worked this out by persuading my doctor to let me do a bunch of abdominal x-rays to examine "fecal loading" at my leisure. So I got a bunch done, including several immediately (within 20 min) of having the very best/largest BMs I ever seem to get. Here's the findings from an x-ray taken immediately after one such enormous movement:

Findings: 
Moderate/severe faecal loading involving the ascending colon extending to the splenic flexure. Moderate faecal loading in the region of the lower sigmoid colon. No evidence of established bowel obstruction. No pneumoperitoneum. Lung bases are clear. No suspicious bony lesions.

So my problem seems to be that I'm perpetually filled to the brim with shit, even when I am pooping regularly and have just had a very large movement. The results from the other x-rays are all the same.

Any suggestions on where to from here?

Do you have the urge to go, but you cannot? Or do you have zero urge to go? (this is the most important question). I HAVE ZERO URGE TO GO...UNTIL I FINALLY GET AN URGE. NOT HARD OR DIFFICULT TO PASS.

Do you have alternating diarrhea and constipation, or just constipation? JUST CONSTIPATION

Do you have nausea, vomiting, acid reflux, difficulty swallowing, or early satiety (getting full really early into a meal)? NO.

Have you had this issue since childhood, or did it begin in teen years/adulthood/after a major life event (surgery? divorce? car accident? mauled by bears?) INFREQUENT POOPS WHEN I WAS A CHILD (I would hold them in so they wouldn't interfere with my playing!). THE GAS, BLOATING, PAIN, ETC ETC BEGAN SOME TIME AROUND AGE 20.

Did you in the past or do you currently take any medications that could damage your intestines?ACCUTANE WHEN I WAS 16-17. PAINKILLERS FOR 6 MONTHS FOR BACK PAIN WHEN I WAS 19-20 (TRAMADOL, CODEINE, PARACETAMOL, NAPROXEN, IBUPROFEN).

Did you suffer sexual abuse as a child? NO.

Have had all bloods, stool, thyroid etc done with GP. All normal.

Have seen gastroenterologist, had colonoscopy, endoscopy, checked for h. pylori - all clear.

Tried more fibre, less fibre, laxatives, FODMAP diet, lots of water, I exercise regularly, prioritise sleep, avoid stress - all to no avail.

In hindsight, I realize that almost all of my problems—physical, mental, emotional—were stemming from my poor gut health. This is a short post on how I addressed my various problems to fix my gut health—in other words, have regular, complete bowel movements of the right consistency.

Context: I had IBS-C (constipation) and frequently went a week or two without having any meaningful BMs. I was constantly backed up to varying degrees. Always. Symptoms included anger, brain fog, lack of motivation, feeling like I’m not strong enough to exercise, sleep quality, acne, lower back pain, despair, dry skin… so many symptoms. But I didn’t even realize these were symptoms of my gut until I fixed my gut! So fixing it was magical in a way. My problem “felt” like absolutely nothing was happening in my gut, no gurgles, no gas, no BMS, I think it’s called low motility.

My gut is not 100% perfect but it is functioning to where I feel like a brand new person so I feel this post is timely.

Fiber/water

Messing with fiber and water intake didn’t do anything for me. Looking up solutions and finding people talking about fiber and water all of the time was infuriating.

Type of diet

The types of foods I ate didn’t seem to have much effect on my problems. I went through lots of phases trying to reduce or eliminate certain foods but it had very little effect.

One exception: meat. My gut seems to have extreme trouble digesting red meat for whatever reason. Might be a facet of my biology or it might be poor gut bacteria diversity. Not sure. Regardless, I stick to cheese/eggs/goat milk kefir for animal protein sources. I do not EVER eat processed red meats like pepperoni, bacon, etc. Bagels and pizza dough also seem to be particularly difficult forms of wheat to digest, but doable.

Whatever concerns you have about protein, macronutrients, etc. — regular digestion trumps all of this, so my 2c is to not worry much about anything besides your gut health. Any diet with perfect digestion > a “healthy” diet with poor digestion. My 2c.

Mindfulness

Bringing your attention to your gut is a powerful tool, but it’s difficult to do if you’re currently experiencing gut problems. The quickest way to get value from this technique is to focus on breathing “into” the space right below your navel, even if it’s just for a second or two. For me at least.

Pelvic floor dysfunction

Ingrained trauma led to hypervigilance and constantly feeling tense. One of the fruitions of doing this was a tight pelvic floor. For me personally, rolling up a towel and sitting on it and sort of moving around and trying to push out rather than clench (hard to describe) was enough to fix this along with some other basic stuff I found on YouTube.

Lots of pelvic floor tightness was caused by gut problems—if I’m backed up, my pelvic floor will always be tight. So it’s a catch 22 there.

Magnesium Citrate (small intestines)

Lots of people talk about the magnesium citrate liquid bottle, which is OK, but the capsules work better, in my opinion. As far as I know, magnesium citrate draws liquid into your small intestines. Taking about 1000mg for a couple days in a row resulted in finally clearing my digestive tract out. If you do it like this instead of chugging 2700mg like what’s in the bottle, you don’t explode, the BMs are normal.

However mag citrate stopped working after those first few days and that initial cleanout.

Miralax (large intestines)

I randomly tried Miralax, and it worked. So I started mixing it with mag cit just to try to make sure I had all of my bases covered. And it stopped working. So I went back to only Miralax. And it started working again.

As far as I know, miralax draws water into the large intestines. My theory is that by taking both mag citrate and miralax, the water was being attracted to both my small and large intestines. But small intestines comes first, so it was getting stuck there and never making it to large intestines.

Salt

It seems like I need more salt than the average person. The RDV for salt is hilariously low for me. Theory is something along the lines of, I have trouble retaining water, so I need more salt to help retain it.

The relationship of water to salt is very important, which I knew about, but never paid enough attention to. For me, I always drank a ton of water, but it never seemed to get absorbed. Eating much more salt helped change this, along with everything else I’m talking about in this post. (I ate a normal amount before, but now I eat more than is generally recommended.)

Basically, just chugging water every day was not enough to hydrate me. I’d drink a gallon per day and still feel dehydrated. I needed this extra stuff to actually absorb the water.

Probiotics

I bought a random probiotic from Walgreens (shelf stable, didn’t know about refrigerated ones when I bought it) and I also drink goat milk kefir from trader joe’s which has probiotics added. I have no idea if these are actually doing anything, because I started taking them at the same time I started Miralax. But they don’t seem to be hurting, so I’m continuing.

Massage

Rather than following massage tutorials on YouTube, I’ve found it’s more effective to just feel around your abdomen, see where it feels non-perfect, and focus your massage efforts there. I have a few areas that seem to need attention more than the rest. My theory here is that certain parts of my digestive tract are horribly pinched/disfigured due to constantly being full of waste.

Theory

Essentially, I had multiple things messing with me. The primary problem was definitely getting liquid into my intestines, but all of them were important, for example without pelvic floor attention BMs were always weirdly thin. If you’ve been experiencing digestion problems for a while, your gut is probably damaged to at least some degree, so you may need to take multiple actions to find relief.

Approach

As I said before, I have recently realized that 100% of my mental, emotional, and physical problems stemmed from poor gut health. Anger, brain fog, lack of motivation, feeling like I’m not strong enough to exercise, sleep quality, acne, lower back pain, dry skin… so many symptoms.

Therefore trying to live my best life with gut problems was impossible and demoralizing. Just a massive handicap.

So, my approach was to do the absolute bare minimum in life and focus everything on my gut health. For example, I stopped running. I would often get extremely dehydrated after running, even if it was a short run on a cool day, which I knew affected my digestion. So in this case, I was being less “healthy”, but focusing more on healing my gut. Once I healed my gut, I naturally started getting the urge to stretch, exercise, and do cardio

My day to day diet

Water, coffee

Smoothie with 3 bananas, half bag of frozen berries, can of coconut milk, half bottle of goat milk kefir, mix in miralax, eat a probiotic pill with it

Generously salted family sized mexican meal, tortillas/beans/rice or potatoes/onions/eggs/beans/maybe one or two other veggies, in quesadillas or burritos. I eat this pretty much every day and use different sauces and vegetables for variation. It’s monotonous but I literally do not care AT ALL because the benefits of having proper gut function are so much more important than the sensation of taste.

The most important part is the beans (fiber) and “bulking agents” (tortillas/rice/potatoes) in my opinion. I think a high fiber diet is ideal for optimal gut health, but it doesn’t matter unless you have foundational issues sorted (water retention, pelvic floor, etc.) and tbh fiber just made things worse for me when I was backed up, never ever solved the issue

Then try not to fall asleep before I drink a lot of water after the family sized mexican meal

This post left out a lot of my thoughts and trials/tribulations, just the core info I included.

Hope this helps someone.

Here are the q/a required by automod:

• Do you have the urge to go, but you cannot? Or do you have zero urge to go? (this is the most important question) No urge

• Do you have alternating diarrhea and constipation, or just constipation? Just constipation

• Do you have nausea, vomiting, acid reflux, difficulty swallowing, or early satiety (getting full really early into a meal)? Yes, for example I'd get so backed up that I'd get violently sick with a migraine and have to yak up tons of stomach acid, which was horrible. No difficulty swallowing

• Have you had this issue since childhood, or did it begin in teen years/adulthood/after a major life event (surgery? divorce? car accident? mauled by bears?) Since childhood, I can remember getting the "need to yak up stomach acid" thing since was very young. But only recently realized it was due to constipation

• Did you in the past or do you currently take any medications that could damage your intestines? The acne drug Accutane/Sotret/Claravis/many other names (isotretinoin) has been linked to serious conditions of the digestive tract. I am absolutely convinced that my large intestine was destroyed by this drug. Antibiotics are also a major culprit in ruining the small intestine microbiome and causing diarrhea/constipation disorders. Antidepressants can ruin the serotonin balance in the gut as well. Not to my knowledge

• Did you suffer sexual abuse as a child? There is a high degree of correlation between childhood sexual abuse and adult constipation disorders. Meaning, a lot of people with chronic constipation disorders in adulthood experienced trauma when they were young. This sort of thing must be investigated by both your doctor and a therapist in coordination. Do some Googling on this topic if you believe this might be your issue. Not to my knowledge, but I did suffer from general abuse/neglect, my ACE score is high, this definitely affected my gut to some degree

Specifically The Vitamin Shoppe store brand. I purchased it hoping it would make my antidepressants work better, while I'm not sure about that, as long as I take 1 pill - 400mcg at night, I am regular and normal, I switched to a "better" brand and became constipated again. Can anyone offer an explanation?

I am also histamine intolerant and in my 60s if that matters.

Hi,

I appreciate the stickied post and the creation of this entire subreddit. It is good to know that I am not alone.

I would love advice (if any people have overcome this) around solving the pain that is in my lower left abdomen. By left, I mean my left facing away from me, and the area corresponds with the descending colon/sigmoid colon.

I am currently in the process of trying to dissect this thing. The timeline of events that has occurred is as follows:

1. March 2020: First onset of lower left abdomen pain

2. April 2020: Constipation, bloating gas

3. May-October 2020: I use miralax and just live with intermittent abdomen pain + bloating + gas. I was able to get a bowel movement every day, so I figured I would just live with whatever I suffered through.

4. October 2020: The lower left abdomen pain returns and I decide that I need to figure out what is going on. I am prescribed trulance, which always me to go through a bowel movement in the morning, but it does not stop the gas/lower left abdomen pain.

I am going to follow the stickied post and seriously get tested for everything in order to get to the bottom of this.

I have tried the following, all of which have not eased symptoms:

• Low FODMAP diet

• psyllum husk fiber

• probiotics

• gas x (which does help, but is it alright to take every day?)

• massaging and wind relieving poses

This is terrible and would love any advice that anyone can give.

Hi everyone, just wanted to post my experience in case it helps anyone because this sub has been a lifesaver for me!

I have been experiencing increasingly debilitating constipation over the last few years. I tried every supplement under the sun and couldn’t find anything that worked consistently. Calm magnesium citrate + cayenne pepper pills was the best combo I found but I was still struggling. I could go every day but it was always incomplete. I had almost no desire to eat and when I did eat my stomach blew up like a balloon.

I finally saw a GI a few months ago who suspected pelvic floor dysfunction. An anorectal manometry confirmed that I have dyssynergic defection, and I have now started PT. But I still felt like I couldn’t eat anything without triggering horrible bloating plus gas that couldn’t get out because of my pelvic issues. Which made the constipation worse—a vicious cycle. And for years I felt like I got full quickly and food sat like a rock in my stomach, and I sometimes have trouble swallowing. So I realized that I most likely have serious longstanding motility issues as well (will be confirming with my doctor in the coming weeks).

I had asked my doctor for a Motegrity prescription a while ago but had been afraid to try it. Partially because of the potential side effects (poor sleep, suicidal thoughts, nausea, headaches). I was also just afraid that if I tried a prescription and it didn’t work, I’d be out of options (not really true, just a feeling).

Anyways, I finally had enough misery and took my first pill yesterday. I was prescribed 2mg but cut it in half and tried 1mg. Wow, did it work. I haven’t felt so completely empty since who knows when. Felt like someone vacuum suctioned my GI tract! If anything it was a little much and made my tummy sensitive so I tried a quarter of a pill today, 500 mg, and had just a perfect day. I haven’t felt this good in years! So far I have zero side effects. I am still taking the mag citrate bc my PFD makes it hard to pass solid BMs, I need to soften it. I will continue with pelvic floor PT.

I just wanted to post this for anyone who’s nervous about trying Motegrity or any other prescription. I know that this med stops working for some people and that cycling on and off may be necessary. I will post updates if people are interested. Good luck to all!! We deserve to feel good, don’t give up trying new things.

PS I recently tried Atrantil for backed up days and it really helps with the bloated feeling.

1. Urge to go but can’t—I have pelvic floor dysfunction/dyssynergic defection. 2. Just constipation. 3. Difficulty swallowing and early satiety. 4. Issue began in mid-20s. 5. No meds. 6. No SA.

Just wanted to share in case it helps anyone else here.

I had IBS symptoms for over 10 years—bloating, constipation, nausea, food fear, anxiety. I tried all the things: low FODMAP, cutting gluten/dairy, supplements, medications, GI specialists, naturopaths, etc. It helped a little, but the symptoms always came back.

Eventually, I realized stress and nervous system stuff played a huge role for me. I was stuck in fight-or-flight for years and didn't even know it. Once I started working on calming my system (nervous system tools, somatic stuff, less restriction), things slowly improved. Like…  really improved.

I still eat carefully but not obsessively. I'm not perfect, but I feel like a totally different person. I don't fear eating anymore. I'm no longer extremely uncomfortable every day. I feel like a normal human!

Not saying this is a magic fix, but if nothing else has worked for you—it might be worth exploring the gut-brain connection. Just sharing in case it resonates.

My answers to required group questions:

1. Not anymore

2. Used to have both, but not anymore

3. Used to be nauseous, have acid reflux, and never really hungry

4. I had these issues since my teen years, but got worse in my 20s

5. Yes, I went on 5 rounds of Accutane, and was put on antibiotics

6. No

Here is my original post: https://www.reddit.com/r/ConstipationAdvice/s/8o7DWvFWkA

I just wanted to share an update in case anyone else is going through this with teens or older kids. We started doing the Modified O'Regan Protocol and I'm happy to say that my daughter is no longer soiling her underwear! The first night we did the enema with her laying in the Sims position for about 15 minutes, she pooped the biggest poop I have ever seen in my life and immediately felt so much better. The next night she pooped another giant poop. She has not had an accident since we started this program, and this had been going on for 7 months. She is feeling a million times better physically and emotionally. She is happier, more energetic, and sleeping better. Neither of us realized just how much constipation was ruining her life before, and she feels like a new person.

I'm still in the process of trying to find a different GI doctor. All the ones I've reached out to won't see patients her age and just refer me back to the doctor we already saw that wasn't helpful. So no updates there yet, but I'm just so glad we have been able to help her in the meantime.

I have suffered from bowel problems since I was a child. I used to be prone to diarrhea but as an adult I tend to suffer more with constipation. For the last 3 months I've been using glycerin suppositories to stimulate bowel movements every day, as I don't have an urge to go otherwise. I find they work really well and I like that it's predictable that I'll have the urge to go 10 mins after using one. Without them I used to go several days between bowel movements which then felt incomplete and we're hard to pass. I also have bad piles, which have been a problem for years, so straining makes them worse. And I am currently waiting for a nerve test to investigate if I have damage on my pudendal nerve as I have been having perineum and vulval pain since July.

Today my GP told me the suppositories are not safe for daily use and that I'm causing my constipation and haemorrhoid issues by using these (despite these issues predating the suppository use). I can't find any information to verify this though. She has prescribed Cosmocol which she said is safe to take long term. She also advised to take senna in addition to this. She wouldn't explain why the suppositories are not safe to use regularly, yet the Cosmocol is. It looks as though both are osmotic laxatives so surely either they are both safe longterm or neither are.

She also refused to refer me to investigate my issues as apparently constipation is just normal for some people- I plan to go back and insist on a referral as I find this ludicrous. Mainly, I am feeling upset about having to take the Cosmocol as I've had it before and hate the taste, plus it gave me stomach pains. If I just wanted to treat the symptoms then I have been having good results from the suppositories so would rather stick with this if possible.

So does anyone know if the advice I've received is correct or can I continue taking my suppositories while I'm investigating the cause of my issues?

Anyone get headaches or migraines when you are not going to the toilet regularly. Nothing to do with straining as I’m not doing that im wondering if it’s a build up of toxins that I’m not clearing out

Hey there!

So, I've decided to create a Colonic Inertia group on Reddit. I didn't realize it was so simple! Many of us are part of the constipation and IBS groups, but colonic inertia is more than just constipation and IBS . It's like dealing with a dead colon where no matter what foods you eat or supplement you take, everything still stays stuck in your system causing constant pain, severe distension, and nausea, among other symptoms. You end up having to overdose on medications like laxatives just to experience some relief, but it often feels incomplete. Then resorting to enemas becomes a regular part of your routine, yet they provide little relief and can be incredibly painful. This becomes overwhelming because you feel like you're in a constant battle with your stomach every day, and it reaches a point where life doesn't seem worth living anymore :(

If you've experienced any of these symptoms, I believe this group is the right place for you! I've realized that I want to help others who are dealing with these issues, although I'm not sure exactly how yet. I'm comfortable talking about constipation and poop now, so nothing is TMI! I've been feeling quite depressed lately while dealing with this, but connecting with people who understand has really helped lift my spirits. I'm currently navigating my own journey, and I hope to update you all soon :)

Just a quick update for you folks who were interested in my participation in the Vibrant Capsule study. The treatment is a very cool idea and I hope it works for some patients, but unfortunately it did nothing for me. After week 3 I dropped out because it was so ineffective I couldn't even remember to take the pill each night. Bummer! Back to linaclotide + prucalopride + tons of exercise.

Bread is still my destroyer. Cruciferous vegetables are good. Cheese bad. Rice good.