Hello! I have been experiencing nasty constipation for first time in my life (55F) due to 2 years of microdosing a GLP-1 for a progressive hereditary adipose tissue disorder. I’ve been working with gastroenterologist - did the MiraLAX Gatorade clean out, and ongoing use of MiraLAX plus sun fiber and hydration. But I’m still constipated (confirmed by xray) which presents as severe diarrhea including some incontinence :-(. Anyway now my dr is wanting me to try 72mcg of linzess and I’m anxious about it as exactly 2 weeks after starting it (it arrives Tuesday) I leave for my annual and only vacation this year in a remote location with no internet etc. I have read the side effects can peak around that time and I don’t want to be chained to the bathroom for my trip (also it’s hot springs and I don’t want to be afraid to pass gas !).

In addition, I have to take thyroid meds in the AM 1 hour before eating or taking other medications so I am wondering if I can take the linzess at night 2 hours after eating or if it will risk having an accident while asleep. I can’t figure out how to schedule this and basically feeling overwhelmed and would appreciate any advice. Thanks in advance. If anyone else here takes thyroid meds and linzess would love to hear how you manage that. THANKS

Answers to 6 questions:

1. have the urge to go and either have explosive watery diarrhea that is going around the constipation or i have very little output. i never feel empty no matter how many times i have the diarrhea which is often several rounds in succession
2. For the last six months, it’s been constipation presenting as diarrhea. Otherwise my whole life I’ve had mixed IBS and SIBO with more diarrhea than constipation, but would alternate
3. get occasional acid reflux. Early satiety due to being on glp-1
4. The “ongoing constipation” per my gastroenterologist has been going on since April of this year - 6 months and counting. Have been on microdose of zepbound (glp-1) for 2 years, no side effects for first year and a half. That is the cause of this
5. I take the glp-1, have taken antibiotics in my lifetime including rifaximin for SIBO. I take a very low (subclinical) dose of an SSRI (sertraline 25 mg)
6. No history of sexual abuse as a child. History of severe psychological and emotional abuse

thanks in advance for any and all advice!

I’m hoping to hear from anyone who has been through something similar or has experience with this type of surgery. I’ve struggled with chronic constipation my entire life. Recently, it progressed to a sigmoid volvulus with a large bowel obstruction. Thankfully, the volvulus was temporarily resolved during a colonoscopy, but I’ve now been told that surgery is necessary to prevent this from happening again.

The difficult part is deciding how much of my colon needs to be removed. My surgeon is recommending a total colectomy rather than just a sigmoid resection because he suspects there is a more widespread issue with colonic motility. His concern is that if we remove only the sigmoid colon now, I could continue to have significant problems with the remaining colon and potentially need another surgery down the road. He also mentioned that if I needed a second surgery later, the anatomy and blood supply could make things more complicated and potentially increase the risk of needing a permanent ostomy.

What makes this decision particularly difficult for me is that, so far, the only prescription medication I’ve tried for my constipation is Linzess. I haven’t exhausted other medication options, and I’m struggling with the idea of removing my entire colon when I haven’t exhausted every other possible solution. I’m currently trying to understand whether a total colectomy is truly the best option for me or whether there are other avenues worth exploring before making such a major decision.

I would really appreciate hearing from anyone who has experienced something similar:

• Has anyone had lifelong chronic constipation that eventually led to a sigmoid volvulus?
• Did you have a sigmoid resection or a total colectomy? How did you and your surgeon decide?
• Did anyone undergo a total colectomy without having tried multiple constipation medications first?
• If you had a total colectomy with an ileorectal anastomosis, how has your quality of life been? How often do you have bowel movements, and do you struggle with urgency, diarrhea, or incontinence?
• Has anyone had a sigmoid resection first and later needed additional colon surgery?
• Were there other motility tests or treatments that helped you make your decision?

I understand that everyone’s situation is different, and I’m not looking for anyone to make the decision for me. I’m just hoping to learn from people who have walked this road and understand what life looks like after these surgeries. This is a major decision, and I want to feel confident that I’ve explored my options and understand the long-term implications before moving forward.

Thank you to anyone willing to share their experience or advice. I truly appreciate it.