Hello @bb03 and welcome to Mayo Connect. Your post is a very familiar one to many of us who deal with chronic constipation on a regular basis. It sounds as if you are doing a lot of good things to deal with this problem. I have had three surgeries of the upper digestive tract and understand some of what you are experiencing.

Are you familiar with Pelvic Floor Therapy? This is a specific type of physical therapist who specializes in treating problems of incontinence, constipation and other elimination issues. A good pelvic floor therapist can offer suggestions on breathing techniques, the specific way of doing abdominal massage, and consumption of food, liquids, and other techniques.

You might feel that you've tried it all before, but I encourage you to ask for a referral and just see if it helps. Do you think it is worth a try?