I know exactly what she means by medical management because I do it. It is up to me to maintain myself to keep stool soft. Constipation is my enemy! It is trial and error with foods. Fresh fruit and whole grain bread along with vegetables and 4 oz protein. Miralax 1 capful every other day and 1 teasp of Metamucil after evening meal. My sigmoid colon was severe with stool less in diameter than my pinky finger. I wasn't sure I would last until I had Balloon Dilation. Look it up and ask for a referral to some one who performs it. Insurance pays for it. I had it done in Feb and now stool is thunb size. It will never be normal and that is okay. I maintain a daily regimen! Good luck!