Full disclosure, I haven’t skimmed through all the posts so this may have already been mentioned, but have you been evaluated for pelvic floor dysynergia?

I thought of it because you mentioned you’ve tried many medications but haven’t had relief.

With pelvic floor dyssynergia, the problem is a lack of proper coordination with the muscles when you’re trying to have a bowel movement. Instead of relaxing or contracting as they’re supposed to, it does the opposite, literally causing a physical back-up. In that situation, no amount or laxative is going to work because there’s no way for the stool to exit.

I have mild pelvic floor dyssynergia. A GI doctor would know of this, but it’s not top of mind for everyone or they write it off as IBS. There’s a test called pelvic floor manometry but it feels kind of invasive and it’s not good for trauma survivors. Instead, I was evaluated by a pelvic floor physical therapist (which does require a physical exam), but she was able to treat the condition, help me retrain the muscles, and teach me other strategies to help with constipation. My case was mild, so we relied more on the other interventions, but I got much more out of working with her than a doctor.

The other thing that popped into my head was methane-dominant SIBO, which causes constipation. I’ve had that too.