Hi,
I am now 7 months into chronic constipation, an interesting odyssey after 17 years of diarrhea with the j-pouch. My G/I doc first thought the constipation was due to a stricture, but nope, a scope ruled that out. Then it was thought the cause was having a rectocele and cystocele, but a uro-gynecologist determined the MRI defecography report was faulty, so nope, not the problem. The results of a recent anal-rectal manometry report determined I have a hypertonic pelvic floor (aka a tight ass 
) and dyssynergic defecation (my anal-rectal muscles are not N Sync). I was referred to pelvic floor therapy and told to expect it to take 3 to 6 months to show improvement. Maybe. If it works. See you in 3 months.
In the meantime, as the past 7 months have rolled by, every trick I have been using (including enemas) have stopped being effective. Last Wednesday I was so nauseous I went to urgent care to ask them to listen for bowel tones. The doc there said they were audible but on the quiet side. His instructions were to immediately begin an extended 3 day regimen of colonoscopy prep level magnesium citrate and clear liquids to flush everything out to avoid a small bowel obstruction, then advance from clear liquids to fulls, and continue drinking 5 oz of magnesium citrate daily when I advanced to eating small meals. omg. The mag citrate. Between the mag citrate and the clear liquids, the flush is working (thank goodness), but I am only on day 3 and I feel faint most of the time. I can't imagine how I will drink 5 oz of mag citrate daily and continue to function.
Question: Anyone have experience with chugging mag citrate daily over the long term as a constipation cure?
Question: Have you been diagnosed with a hypertonic pelvic floor and/or dyssynergic defecation and engaged in pelvic floor therapy as a cure for constipation? Was it helpful? Anything more helpful or other ideas? I have been combing through jpouch forum posts on pelvic floor therapy addressing a variety of ills, but have not yet found anything definitive on pelvic floor therapy for constipation.
I did find a helpful post by @StarryNight from 2020 describing an intense 2 week treatment experience at Mayo Clinic's "Bowel Evacuation Disorders Clinic" (for a different bowel disorder). I tried to call Mayo to learn more about what's involved, but after an hour with a very nice but new Mayo employee, we learned my primary care doctor needs to call them and explain why I would need such a program, or, the very least, write a letter detailing all the reasons it would be beneficial for me to participate in a 2 week program aimed at addressing pelvic floor related constipation and then they *might* call me back to describe the program. Or they won't call me back if the doctor's letter is not convincing.
To cap it off, I am not 100% certain the pelvic floor is the main problem. It seems like something is wrong much further up, or why wouldn't Miralax, dulcolax, biscodyl suppositories and saline enemas clear it out? Sheesh. Jpouch life is a continual learning adventure - and that's a good thing. I just wish I had a knowledgeable jpouch clinic near me.
I do sincerely apologize for the epic novel. If you've read this far - thank you kindly - I'm grateful. 