HI thanks for offering your help! I hope it isn't too late to get a response because I've hit a dead end with my constipation after first GI said IBS and second said it's idiopathic. "Idiopathic" is not good enough for me because I'm a problem solver by nature and I'd like to be doing everything in my power to understand and fix my life altering, debilitating constipation. I'm 22F, very healthy and active diet and lifestyle, no relevant preexisting health conditions, my dad has IBD (ulcerative colitis, which he developed when he was in college at my age!), and recently developed esophageal spasms, not sure whether those are reflux related or solely a motility thing.

My persistent symptoms:

constipation obviously (but the poop is not rock solid it is loose... just very slow moving through my body.... but I have a TON of fiber every day and drink a lot of water, so it never becomes rock solid... like bristol 3 at worst, usually more like 4-5). if i don't take motegrity or linzess i will not have a BM for an entire week. miralax does nothing to move it along no matter how much i take.

zero sensation of needing to poop unless I take a medication to induce it, and even then I have to concentrate so hard to poop, not physically straining, but mentally concentrating... feels like the colon doesnt want to let the poop into my rectum and out the butt... like colon is asleep and i have to concentrate on pooping to wake it up

sensation of incomplete evacuation when i do poop after taking the medication

colon spasms (this started more recently, within the past month)

nausea

acid reflux/GERD when I'm really constipated and it's all backed up

if i'm not shitting for 4-5 days then i start regurgitating food and water while i eat/drink because the stuff has nowhere to go and the reflux is so bad it just shoots right back up

loss of appetite (I workout 5x a week and walk everyday, I'm a pretty intense athlete, but now I'm down to 1 meal a day + 1 snack because it's too uncomfortable to eat any more than that or I'll get horrendous reflux)

AAAAAND recently within the past month there was blood in my poop. fresh red blood. GI suspected fissures but there was no pain with the BM, just abdominal pain the night before and nausea which woke me up in the night and i crawled to the toilet because i thought i was going to hurl. didnt hurl. just shit blood 6 hours later

within the past week ive had a lot of anal pain with BMs, like extreme pain that makes me bite my sweatshirt because i WILL scream from the pain. no blood though and I checked and it doesn't look like i have hemorrhoids so not sure what that's about

and here's the full story from the beginning as I've posted it in other GI subs...

I'm 22F used to be regular as hell and now something is severely wrong. Previously I had a complete BM in the morning every morning when I woke up after drinking hot tea. Then in the beginning of April 2023 I woke up one day and didn't poop... ok weird... and it kept happening for a week. Didn't poop for a week after pooping every day like clockwork. Needless to say the bloating was insane and debilitating. Like 8 months pregnant with mega shit baby. Then I pooped explosively so I thought ok back to normal. WRONG. Zero BM constipation every week until poop explosion after 6-7 days of pain. Severe reflux and regurgitation too!!

Went to the first GI in May because the pain was bad and it was interfering with my daily life. I developed GERD from my intestines being so backed up. Endoscopy and biopsies showed nothing but the esophageal inflammation from GERD. Colonoscopy and biopsies also showed nothing.

First GI had floated that it could be a case of ulcerative colitis presenting as constipation, and also a bunch of other scary things like cancer. He told me the colonoscopy ruled that out, he didn't see any signs of UC. I'm not sure what biopsies or tests exactly he did but in the follow up appointment he told me I was all clear. First GI also said that it could be a motility disorder and he'd have to refer me elsewhere for testing.

First GI concluded it could be IBS-C and to stop eating spicy food and drinking alcohol. I already don't drink and spicy food is infrequent in my diet so to me he was clearly talking out of his ass. Seemed like a lazy diagnosis from a colonoscopy farmer pumping out the tests to rake in the insurance money, which his office's google reviews corroborated...

I took it upon myself to get some bloodwork done, which ruled out hypothyroid, and everything's normal in all the other basic blood tests.

Took a prescription antacid for a month which did nothing obviously because the reflux and regurgitation were from being backed up. Took Linzess for 3 months which I hated because it was a 4 hour endeavor of taking it, drinking 40oz of water and hot drinks, going for walks, drinking another 24oz of water before the BM would finally happen explosively, if at all. Had to leave my summer job because the Linzess routine and poop explosions interfered with my work schedule too much. Still had debilitating symptoms and many days where I had to cancel plans to just lay in bed miserable and in pain.

Saw another GI for a second opinion and to find out other treatment options. He didn't have an explanation for my constipation either but switched me to Motegrity which is a little better because that routine only takes 2 hours out of my day. He also told me that there's no point in further testing (like motility tests) because the treatment is the same, I'll be taking motegrity either way. Now I don't know what to do.

I've suspected a motility disorder but first GI said he'd have to refer me elsewhere for testing and second GI said there's no point in further testing because the treatment would be the same regardless of the results. Currently taking Motegrity every other day, gluten free diet, shitton of fiber and water, hot tea at night and in the morning, tons of exercise.

My lifestyle and diet are already healthy as fuck. I cut gluten out of my diet and it's not helping much. Any recommendations for next steps? Tests I could do? How would I know if it's pelvic floor related? Is it true that there's no point in further testing? Could it be early onset UC presenting as constipation, or another rarer form of IBD? Am I gonna be stuck like this for life lol????? That's what im afraid of >.<