Hello Thank you for sharing these details—chronic constipation like this can really affect your quality of life, especially when it’s been going on for years. Since your symptoms started after sinus surgery and you had normal bowel function before, it’s possible that changes in routine, medications, or even stress from surgery played a role, but now it’s become a long-term issue.
Here’s a structured approach to help you:
### What Might Be Happening
- Functional constipation is most likely, especially with hard stools, straining, and incomplete evacuation. - Sometimes, chronic constipation can be due to slow gut movement, pelvic floor dysfunction, or rarely, a side effect of medications or underlying medical conditions.
### What You Can Do
1. Diet & Fluids - Increase fiber intake slowly (fruits, vegetables, whole grains, isabgol/psyllium husk). - Drink 2–3 liters of water daily. - Avoid processed foods and excess dairy.
2. Routine & Habits - Try to go to the toilet at the same time every day, preferably after breakfast. - Don’t ignore the urge to go. - Give yourself enough time and privacy.
3. Physical Activity - Regular exercise (walking, yoga) helps stimulate bowel movement.
4. Indian Home Remedies - Warm water with lemon in the morning. - Soaked raisins or figs overnight, eaten in the morning. - Triphala churna (an ayurvedic powder) at bedtime—ask your doctor before starting.
5. Medical Review - Since this is chronic and not improving, you should see a gastroenterologist. They may suggest: - Blood tests (thyroid, calcium, sugar) - Colonoscopy (if there are any warning signs like blood in stool, weight loss, or family history) - Tests for pelvic floor function if needed
6. Medications - Avoid self-medicating with laxatives for long periods. Your doctor can prescribe safe options if needed.
### When to Seek Urgent Help
- Blood in stool - Severe abdominal pain or vomiting - Sudden weight loss
You’re not alone—chronic constipation is common and treatable. With the right approach and sometimes a little patience, things can improve.
Thank you
Your history is most consistent with chronic functional constipation, very likely a form of outlet dysfunction (difficulty expelling stool) rather than a simple diet-related issue. The key clues are the persistent urge, excessive straining, long time in the toilet, and feeling of incomplete evacuation—especially since stool can sometimes be normal in consistency but still hard to pass. The fact that laxatives help temporarily but symptoms return suggests the underlying problem is not being corrected, and your hemorrhoids are likely a result of long-term straining.
To move forward properly, you need a structured approach rather than irregular laxative use. First, your routine should be optimized: fixed toilet timing (especially after meals), proper posture (using a footstool to mimic a squatting position), and avoiding prolonged straining. Medically, instead of random stool softeners, a regular osmotic laxative like Polyethylene Glycol taken daily is more effective and safer long-term, sometimes combined with a stimulant laxative short-term if needed.However, the most important step in your case is evaluation for pelvic floor dysfunction—tests like anorectal manometry or balloon expulsion test can confirm this, and if present, biofeedback therapy (a specialized physiotherapy) can significantly improve symptoms and even reduce dependence on laxatives.
Additionally, ensure adequate fiber (but not excessive, as too much can worsen symptoms in outlet obstruction), hydration, and regular physical activity. Since your symptoms started after surgery and have persisted for years, a consultation with a gastroenterologist is important to rule out conditions like dyssynergic defecation. In summary, this is a chronic but treatable condition, and with the right diagnosis and targeted therapy, you can achieve much better long-term control instead of relying on temporary relief.
Hello dear I think due to side effects of medication for surgery Bowel movements have been affected I am suggesting some tests for confirmation of exact diagnosis and best treatment Please share the result with gastroenterologist or general physician medicine for better clarity and for safety please donot take any medication without consulting the concerned physician Serum ferritin Serum RBS Stomach USG Urine analysis Rft Lft Culture Endoscopy Anascopy if recommended by gastroenterologist Rectal physical examination Esr Cbc Hopefully you recover soon Regards
Hi Mohammed, thanks for sharing your history. From what you’ve described, this looks like chronic functional constipation, and more specifically it suggests a defecation disorder (outlet obstruction / dyssynergic defecation) rather than just “simple constipation”. Your pattern strongly points toward a coordination problem of pelvic floor muscles, not just hard stool. Your sinus surgery is likely coincidental, not the direct cause. Normally during defecation Rectum contracts & Anal sphincter relaxes. In your case, The muscles may be not relaxing properly or even tightening & hence Stool cannot pass easily despite urge. This also explains your hemorrhoids (due to chronic straining). You need evaluation by a gastroenterologist, specifically for Anorectal manometry (tests muscle coordination) ± Balloon expulsion test. These are key to confirm the diagnosis. Treatment-
1. First-line and most effective is Biofeedback therapy. This is the best treatment for dyssynergic defecation. Trains your pelvic floor muscles to relax properly. Success rate is very high (60–80%). This is often the missing step in patients like you.
2. Regular bowel regimen (must be consistent, not intermittent)- Instead of irregular laxative use, follow a structured plan: -Osmotic laxative (daily): Lactulose OR polyethylene glycol (PEG) -Fiber (gradually increase): Ispaghula husk (psyllium) -Adequate fluids: At least 2–3 liters/day. Irregular use is why symptoms keep returning.
3. Correct toilet habits- Go only when you feel urge (don’t force daily attempts). Use footstool (squatting position). Limit toilet time to <10 minutes. Avoid excessive straining.
4. Physical activity- Regular walking/exercise improves bowel motility.
5. Hemorrhoids care- Will improve once straining is controlled. Sitz bath + stool softening helps.
When to investigate further?- Even though you currently have no alarm signs, consult urgently if Blood in stool, Significant weight loss, Severe abdominal pain or Sudden worsening. This is most likely a pelvic floor coordination problem, not just constipation. Biofeedback therapy + regular (not intermittent) laxative regimen is the key to long-term relief.
Feel free to reach out again.
Regards, Dr. Nirav Jain MBBS, D.Fam.Medicine
Hi Mohammed – thanks for the extra details. Here’s exactly what to do for 5+ years of post-surgery constipation that laxatives only mask:
🔍 Step 1 – Understand the likely cause
Your story (normal before surgery, urge but can’t pass, straining, incomplete emptying) points to pelvic floor dyssynergia – muscles tighten instead of relax during pushing. Surgery/anesthesia can sometimes trigger this. Laxatives won’t fix it.
✅ Step 2 – Get the right test
Ask your doctor for:
· Anorectal manometry + balloon expulsion test · Defecography (if available)
🧠 Step 3 – Best long-term treatment (not laxatives)
· Biofeedback therapy – retrains pelvic muscles. 70–80% success. Works permanently. · Pelvic floor physical therapy – hands-on muscle relaxation techniques.
💊 Step 4 – While waiting for testing
· Daily PEG (MiraLAX) – safe for months. Take every morning. · Stop stimulant laxatives (if using) – they cause dependency. · Increase fluids – you noted decreased intake. Target 2–2.5L water/day. · Scheduled toilet sitting – 5–7 min after breakfast, no straining, feet on a small stool.
🚫 What to avoid
· Ignoring the urge → worsens dyssynergia · Prolonged straining → worsens hemorrhoids
Bottom line: This is not “lazy bowel.” It’s a muscle coordination problem. Biofeedback + pelvic floor therapy is the cure. See a gastroenterologist (motility specialist) for testing.
— Dr. Nikhil Chauhan
Chronic constipation persisting for over five years can be challenging, especially when it follows an event like sinus surgery. The key here is to identify and address potential underlying factors while improving bowel habits through safe, effective methods. Post-surgical changes, such as pelvic floor dysfunction or altered bowel motility, might be contributing. First, consider a thorough evaluation by a gastroenterologist to rule out structural causes like obstructions or motility disorders. They might recommend tests like anorectal manometry or colon transit studies.
In the meantime, optimizing lifestyle strategies might help. Focus on dietary fiber intake, aiming for 25-30 grams per day through fruits, vegetables, and whole grains. Ensure adequate hydration—about eight glasses of water daily—while gradually introducing fiber if it’s currently insufficient to avoid bloating. Regular exercise can also enhance motility; aim for at least 150 minutes of moderate activity weekly. When it comes to laxatives, using them consistently but cautiously under medical advisement rather than intermittently might improve outcomes. Agents like polyethylene glycol are often well-tolerated for longer-term use.
Consider pelvic floor physiotherapy too, as it can aid those with pelvic floor dysfunction leading to constipation, especially when experiencing significant straining. Given your situation post-surgery, it may help address any muscle coordination issues. Additionally, reviewing all current medications with your healthcare provider is prudent, as some antihistamines can contribute to constipation. Avoid delaying medical consultation if there’s new or worsening symptoms—especially sharp or persistent abdominal pain or changes in stool caliber.
