Quick background - I have had constipation my entire life. Even as a kid, I ate bran cereal every day. Now that I am in my 60's, my problems are worse. I eat super high fiber cereal (homemade - 30 grams of fiber per bowl) almost everyday and usually salad or beans (or both) each day. But high fiber alone didn't solve my problem.
Most days, I feel like I am passing a "golf ball" when I start to go - if I even *can* go that day. If I don't go each day, it is much, much worse - so I try to go each day. When passing the "golf ball", I get rectal bleeding that rarely heals on its own, so I have to use steroid creams for that to heal. Not good either!!
I tried several medications (linzess, etc.) with fiber, but that didn't solve the "golf ball" problem. I tried Miralax (which adds liquid to your bowels) - without linzess, but that was too much liquid, and still didn't solve the problem, and it was very messy.
I found out from another doctor that Miralax alone causes other problems. The main issue for me is that the hard stool spends too much time in the colon because the colon reabsorbs too much water from the stool. So the other doctor suggested to add psyllium fiber (Metamucil) to the Miralax. Psyllium fiber increases the speed of material through the colon and it binds the stool together, thus helping with the absorption problem and it isn't messy.
Now My Solution: So now I take a dose of psyllium fiber in the morning with breakfast, then a dose of Miralax mid-day, then a dose of psyllium fiber at dinner. Before bed, I take 2-3 tablets of Colace (OTC stool softener) before bed. When I wake up around 6 am I take a dose of linzess. Then when I get up (around 9 am), I usually go right away, with no "golf ball" issue. Then I usually go *again* sometime in the afternoon. It is a lot to manage, but it is MILES better than what I had before. I also make sure I drink about 50+ ounces of water each day, and I still eat a lot of fiber.
I hope that this helps someone. It took me a long, long time (and a lot of pain) to get to this point. I am still experimenting so I will edit this post with any updates.
EDIT: I did forget to mention that I was diagnosed with Irritable Bowel Syndrome with Constipation (IBS-C) around 2021.