cpeffer,

You have a very hard stool. I used to have that problem. Eat lightly - no need to add more "stuff" to a clogged pipe - until you clear out.

Liquids like Miralax do not work for me at all. I just get nauseous and don't poop. Enemas are only good if your rectum is full of stool, and again, they may not work if your stool is very hard. I had little success with such.

A regular pill form stool softener / stimulant laxative works for me. Maximum labeled dose. Have you tried that?
My gut is sensitive and a Gastro way back recommended (now it is called) Colace Plus. Get the brand not the generic. It makes a difference. Of course, take it at night as directed.

When you feel like it is time to move your bowels (for me, that is after breakfast), try drinking a glass of very hot water. As hot as you can bear. The heat is an additional stimulant to move the stool. It really speeds things up for me.

That is all I have on that topic.

Once you are cleared out, you really have to look at a few things:

Your diet - some food simply may plug you up -- your gut just doesn't digest it/them properly. Maybe once it did, but not anymore. So many foods constipate me. I basically "eat to poop." Try eating food that you can tolerate that keeps stool soft and makes you poop by either keeping stool soft or stimulating the colon -- whatever works -- prunes, prune juice, spinach, rhubarb, kiwi (yes, a study supports kiwi) and whatever else is out there that I don't use.

(I really can only deal with about 15 different foods and mostly porridge and soup. Not much raw at all. Vegetarian. Grain-free. Your solution may be in your diet. Hopefully, not as limited.)

Check out your supplements. For example, Melatonin seems to "kill" my motility and yep, there is a study/medical info on that.

Water - Nothing like it. Have it on hand to sip and drink throughout the day. (And do the hot water trick in the a.m.). You can drink other things, but you need plain water. Somehow, it gets into your colon better to keep stool soft and moving.

Consider a magnesium supplement (do your research) to keep stool soft.

Consider slippery elm inner bark powder (I put it in my hot cereal (porridge) and in hot drinks and backed items. It adds mucous to your colon, so stool slips along better. I use some (1/8 teas) with every meal and snack.

Consider gut massage (Google NHS and constipation and massage). The UK's National Health Service has good information.

Cardio exercise helps. Floor stretching with your legs -- hamstrings, knee to chest stretches -- helps. Squishing your gut with stretches can move things along.

Make sure you don't have a redundant (i.e., extra long) colon (I have one, and it makes digestion more difficult). Heather's peppermint capsules help fire my digestion and move things along and through my extra-long colon.

Make sure you don't have a rectocle (a stretched rectum/pocket where hard stool can get stuck). I have one, but if I keep my stool soft, it doesn't come into play.

Lastly, if you can sleep on your left side. It helps your stool move along.

Hopefully, one way or another, you will get the stool out. In the old days, or even now, the MDs can go in and physically remove the stool. Makes no sense to wait for a rupture. That is insane. Maybe you just need to go to the E.R. (if you haven't done that yet).

Good luck! I am sorry you are in pain right now. That is rough.

You will find an answer to prevent your constipation. Just trial and error. Keep a journal to help you remember what works and what doesn't. Once you get it down, it will all become habit and the good times will return.