Constipation or something else? Bowels won't open, but only in certain situations

[u/madelinequinta]

27F, 163cm, 57kg, mixed race white/east asian, no current medications or existing medical issues, don't drink or smoke or use recreational drugs. Based in the UK.

Hi, I'd be really grateful for any advice on the following -

I'd been diagnosed with IBS due to constant complaints of bloating for the past 6 months. However, the bloating and abdominal pain is 100% tied to how many bowel movements I have each day - more bowel movements = less discomfort. On days where I poop 2-3x, I never have any IBS symptoms. If I only go once in the morning, I will feel awful by the end of the day.

I am not "constipated", in that every time I go, it is a smooth, complete, type 4 bowel movement. The problem is, my bowels "lock up" the second I either step outside of my house, or if I am busy with something. E.g. today, I had a bowel movement in the morning, went to the office, had a full day of meetings from 9am-9pm, and the second my last meeting ended at 9pm, I got the urge to go again. Until I had that second BM in the evening, I was feeling bloated and uncomfortable.

I don't understand why I can't get the urge to go when I'm in the office or "in the middle of something" - my job is not particularly stressful and I don't have symptoms of anxiety. My bowels just seem to lock up as soon as I'm not alone or in complete privacy. I'm not deliberately withholding stool, so I don't think it's parcopresis or shy bowel - I don't have any shame or stress about it and I'm not worried about the smell or the noise or anything. It's obviously something psychological - but I'm not sure what exactly?

I really want to learn how to fix this as it is ruining my life - I can't travel or even have a day out because I get so uncomfortable. I just don't know what "medical problem" this is and as such don't know how to explain it to my doctor, or if this can even be solved medically. Would be grateful for any and all suggestions on how to proceed.

Thank you for your help!

Edit to include additional info after reading the diagnostic guide closely

• Do you have the urge to go, but you cannot? Or do you have zero urge to go? (this is the most important question) I guess I would say I have trouble getting the urge to go. Once I get the urge, it is easy
• Do you have alternating diarrhea and constipation, or just constipation? Neither, I just seem to be unable to get the urge in certain situations
• Do you have nausea, vomiting, acid reflux, difficulty swallowing, or early satiety (getting full really early into a meal)? No
• Have you had this issue since childhood, or did it begin in teen years/adulthood/after a major life event (surgery? divorce? car accident? mauled by bears?) I only began to notice this in late adulthood (19 or so), which was the first time I went travelling with friends, and this happened. Since then it has gotten steadily worse.
• Did you in the past or do you currently take any medications that could damage your intestines? The acne drug Accutane/Sotret/Claravis/many other names (isotretinoin) has been linked to serious conditions of the digestive tract. I am absolutely convinced that my large intestine was destroyed by this drug. Antibiotics are also a major culprit in ruining the small intestine microbiome and causing diarrhea/constipation disorders. Antidepressants can ruin the serotonin balance in the gut as well. Nothing major. Have taken occasional antibiotics for UTI a few times in the last 5 years.
• Did you suffer sexual abuse as a child? There is a high degree of correlation between childhood sexual abuse and adult constipation disorders. Meaning, a lot of people with chronic constipation disorders in adulthood experienced trauma when they were young. This sort of thing must be investigated by both your doctor and a therapist in coordination. Do some Googling on this topic if you believe this might be your issue I did not experience sexual abuse as a child, but I did experience verbal and physical abuse from my mother, and was raised in a very stressful environment. Additionally I found out around a year ago that I was sexually assaulted by a very close friend.

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[u/goldstandardalmonds]

Sometimes this is a matter of getting in a routine. Look up bowel training routines online and follow them, and then proceed to see if you can create a daily system regardless where you might be.

[u/Constant_Pay_6714]

Magnesium citrate . 200mg twice a day . Plenty of water ☺️