[Update] 90 days later - I'm cured! See updates at end of post.

Hi all, thought I might share this success story of how I beat constipation.

I've had terrible constipation my entire life, and mainly for the past 4 months, only going once every 4 to 5 days, always very dry and rock-like. I was so constipated that my belly was usually swollen, hurting, and pressing on my backbone. Sleep was difficult. It also didn't help that I wasn't sleeping more than 2 to 3 hours a night due to an injury. I was willing to try anything to get my health and sanity back.

Now I have one perfectly healthy bowel movement every morning like clockwork. It's absolute magic, I can feel myself getting healthier every day.

How did I do it?

I talked to a health practitioner who has treated thousands of patients. He knows that works, and what doesn't, based on dealing with a lot of sick people. He recommended the following, and it worked absolutely brilliantly.

The most amazing thing is that it worked from day 1. It was absolutely incredible. When I stopped point #4, everything continued on like a normal person.

1. Drink 2L to 2.4L of water per day

• Sip it slowly throughout the entire day. This means that the kidneys can keep up. Gulping 1.5L at once will overload the kidneys and lead to water retention. Divide that 2.4L into equal chunks so you get through 1L prior to 11am, and the rest prior to bedtime.
• Myth (sprinkled all over the internet!): don't drink any water 30 minutes prior to a meal, and 1 hour after. Reality: the stomach has a very ingeneous arrangement where small amounts of water flow under the bolus of food straight into the small intestine. It's okay to sip small amounts of water, it won't affect digestion much.

2. Magnesium Citrate

Start with a 1400mg pill providing ~400mg of elemental magnesium prior to bed. This is the RDA, its perfectly safe. If things are not working, increase to 800mg elemental, some people even go up to 1200mg elemental which is 3x RDA, and perfectly safe. Find the level that works for you. At this level, it's above RDA but these levels can be sustained indefinitely. As the bowel gets going, could reduce.

• Myth (everywhere on the internet). Magnesium citrate is an osmotic laxative, it will cause water retention. Reality: it doesn't, quite the opposite.
• Myth (everywhere on the internet). Magnesium citrate can cause dependency. Reality: it doesn't. Once the bowel is moving again, can titrate down.

3. Probiotics

Kimchi or sauerkraut with every meal, or a good probiotic.

Update: another Reddit user recommended a fix, this adaption works for me: 5 tablespoons of chia seeds, 5 tablespoons of Kefir in 1.5 cups of water. Soak overnight in fridge. There should be sufficient water so that the chia seeds are fully soaked; there should be a little bit of free water on top. Drink 1 cup of this per day. This acts as a fantastic prebiotic, and helps with constipation as it gives bulk to the stool.

4. Coffee

As described at https://www.trulyheal.com/why-coffee-enemas-are-truly-magical/ and Coffee Enema Recipe and Instructions. Some myths that needing busting before I would even try this:

• Myth: this is not conventional medicine, therefore it is pseudoscience. Reality: This technique has been successfully used for a very long time in many cultures. It's only western medicine that started frowning at the very idea, presumably as they can't sell more drugs if people are treating themselves.
• Myth: it's not Paleo. Our ancestors didn't do it, so we shouldn't either. Reality: out ancestors did a lot of other things that prevented constipation. We are not our ancestors.
• Myth: it's too gross to even think about. Why would you go there? Reality: I was willing to try anything to fix my constipation. I was in pain and my health was failing. This worked for me.
• Myth (sprinkled over the internet, not hard to find!). It's not safe to use continuously, it "creates dependency" and "dries the bowel out" and and "it's dangerous". Reality: it is safe; the bowel is very robust, you can use it continuously for 6 months and when you stop everything will carry on as normal. If you don't believe me, talk to a health practitioner who has worked with thousands of patients and get their opinion.
• Myth (pushed aggressively by the Google filter bubble). Some people have had a perforated bowel. Therefore, all enemas should be discouraged under all circumstances. Reality: The bowel is very robust, it's absolutely safe. The only examples in the literature are a few case studies of very old people with a thin bowel wall, usually with some sort of dementia with everything that implies.
• Hint: If the liquid is held in for about 10 minutes, you will hear a gurgle in your liver. That's the liver expelling bile. Hold until 15 minutes then you're done. I didn't believe it when I heard it, but it happened just as the practitioner said it would. If it doesn't, up your magnesium slightly, take magnesium on an empty stomach the night before, increase coffee up to 3 level tablespoons, water up to 900ml.
• Hint: use coffee specially designed for enemas. Light roast, etc. Make sure it's cooled down to skin temperature.
• Hint: when brewing the coffee, the grounds won't dissolve. Have to strain them out. It's not instant coffee like Nescafe.

What else did I try?

Everything. All kinds of commercial laxatives, some of them led to water retention which is not nice as tissues swell up (beware of any laxative that is in the class of osmotic laxative). Copious amounts of water. Magnesium (didn't work by itself). Bowel self massage. Watched tons of YouTube videos. Castor oil. Running. The thing that actually worked in practice was intervention #4.

I also tried many of the off-the-shelf suppositories with absolutely no success. The glycerol ones didn't work at all, and they gave me terrible water retention so my feet and hands swelled up painfully. I could barely walk. Miralax gave temporary relief while I was using them, but as soon as I stopped the issue came back. They never appeared to fix the underlying cause of the issue like intervention #4 did. Its almost like all of the commercial pharmaceutical suppositories and pills are designed to cover the symptoms, rather than fix the root cause like intervention #4 appeared to do. See latest update at base of post.

Summary

Anyways, hope this is useful to someone. It certainly relieved my suffering, and it was only the occasional 20 minutes of my time to get things moving again.

Wish I had known this 4 months ago.

Update

Update 9 days later. I stopped intervention #4 for a week, and still had perfectly healthy stools every single day. My gut is now the healthiest its been in 5 years. Its like something just got fixed in my gut and its working nicely now, and all I need is interventions #1, #2, #3.

Update

Second opinion from another health practitioner. Apparently, Magnesium Citrate is great but it has one potential downside with long-term use: it alkalines the gut. A slightly alkaline gut can result in fungal issues, e.g. candida. The gut should be slightly acidic to prevent this. I did notice that if I took the occasional teaspoon of organic Black Seed oil that I felt a lot better, which indicates some sort of gut dysbiosis. Another approach is to use vitamin C, look up "ascorbate flush". I havn't tried this.

Update day 15

Given that my constipation might have been caused by some sort of gut dysbiosis (e.g. candida or SIBO), am doing a stool test "CP+P Culture PCR + Parasitology": https://regeneruslabs.com/products/comprehensive-parasitology-x3-cp3. Based on these results, can decide what to do if there is any imbalance of flora.

Update day 21

After 21 days, my constipation is now mostly a memory of the last 10 years.

Havn't sent my PCR test off yet.

Updated section "3. Probiotics".

Update day 40

Everything still working perfectly. Am doing #4 above every week or two. It took 10 days of doing it every day to let everything heal, after that I was fine.

Update day 90

I could consider myself to be cured. No issues whatsoever, and I don't need to do anything. No coffee enemas, no magnesium, no focus on water, no need for probiotics - I'm healthy. This is the best I've been in 15 years.