Ahh, I see. Believe it or not, although I live in a large metropolitan area, it has taken me years to amass the resources I mentioned.

I’ve had chronic pain for years at this point, and the default has been having to do research and advocacy on my own. It’s frustrating for sure.

There is a type of SIBO (methane dominant) that causes slowed motility and constipation, and it is harder to diagnose via breath test than the other one. But if you feel you’ve ruled it out, totally respect that.

Most of this I learned from various books and online resources if finding a provider is out of reach. They specifically focus on patient education and self management because it’s so difficult to get help for gut issues. For example, if you were interested in abdominal massage to help motility, there are YouTube videos by pelvic PTs available online.

I’m also thinking of one author who’s a GI dietician who structures her books as diagnostic quizzes similar to what she uses in the clinic—her books helped me. And many GI dietitians provide services virtually and across state lines, which insurance can cover unless you have Medicare. In that case, Medicare stupidly doesn’t cover a dietician except in highly specific cases. Cash pay adds up but someone who’s the right fit could be really helpful. Integrative or holistic doctors also tend to offer virtual visits, especially if you find someone in-state.

There’s even a GI dietician/psychologist team I follow who just put out a book and started a podcast focused on actionable tips. I’m happy to list some of them off in case you want to look into them for your research. I can send some along when I’m in a spot where I’m sitting still, but no obligation.

I’m not familiar with your condition where fiber causes inflammation, but Sunfiber specifically is IBS-friendly and has been shown to help both diarrhea and constipation, and improve the amount of good bacteria in the gut. It’s very well-tolerated (and I say this as someone who usually doesn’t tolerate things that are well-tolerated), but it sounds like you may have a different condition.

With hydration, I have POTS, which requires a lot of fluids but like you said paradoxically GI symptoms make it hard to take in fluids. So I rely on electrolyte supplements (Klaralyte is in capsule form) and electrolyte solutions—Skratch Labs and Tailwind make good low sugar (real sugar is required for electrolyte solutions to work properly) and sugar-free versions without fake sugars that don’t taste horrible. The electrolytes help your body absorb more water (as opposed to losing it through urine and sweat) so it’s especially helpful for me because I struggle to take as much in. I’d like to think it also helps the constipation.

It’s super frustrating, but there are options.