You have a patient who comes to clinic for management of constipation- she is 35, has no history of abdominal or pelvic surgeries, past medical history includes anxiety. She has been tried docusate, senna, fiber, is physically active, and laxatives in the form of polythele glycol but still complains of feeling of straining and incomplete evacuation. She has bowel movements once a week that are lumpy.
No rectal bleeding. Current medications are Senna, sertraline, senna, docusate, and a laxative. What is your management strategy?
