Hi fellow constipation gang!

Hope everyone's hanging in there.

First a (brief) summary of my situation: I developed debilitating IBSC, nausea, pain, bloating etc etc in December 2022 and had to drop out of school and have been out since then.
Finally got seen at Mayo Clinic after a year of neglectful doctors both western and alternative, and a variety of failed treatments.
Diagnosed with an evacuation disorder (very tight pelvic floor) as well as general constipation and hypersenstivity of the gut. A regimen that is working with me is amitiza 8 mcg 2x daily, plus morning Miralax and a fiber rich smoothie with spinach, berries, banana, kiwi, etc. also amitryptiline 25 mg busparone 30 mg.

The conclusion I have got from this visit is that there are two types of constipation that cannot be treated the same. (1) constipation due to motility (slow colon) and (2) constipation due to osmotic deficiency. A slow colon can be diagnosed with a colonic motility exam which uses radioactive tracers, and osmotic issues are at fault when there is no underlying motility problem. Additionally, long term constipation and straining leads to hypertonic pelvic floor problems which can perpetuate constipation even if the underlying problem is being fought with fiber pills, miralax, etc etc etc (we have all been there).

If you don't have motility issues, taking senna or dulcolax is innappropriate. Similarly, if you don't have osmotic issues, taking miralax will also be unproductive. You need to approach with knowledge, and these require specific tests that doctors won't give because they don't take people seriously, which is a problem in its own.

Second, if you've been constipated for a while you may have developed pelvic floor issues which need to be sovled with pelvic floor physical therapy in tandem with osmotic/motility assistance.

I see a lot of people on this sub who are desperate to find that "magic pill" and it doesn't help that you see posts where people are magically fixed by some supplement. It's great that it works for them, but for the majority of people with long term constipation the solution is more multifaceted and requires knowledge of why you are constipated, since not all constipation is the same.

I hope this was helpful and did not come off as unsympathetic. I am glad I've found something that works and want you all to know that I had given up a long long time ago and just feel lucky to still be here and want to spread what I have found to folks who may be in a similar state of despair and frustration.

Good luck and please reach out with questions!

Tal