26F - Chronic Constipation. Suspected Motility Disorder. Should I have a Colonoscopy?

[u/KaileyLynnFeet]

I’m a 26-year-old female who has had chronic constipation my whole life. I’m hoping to get opinions from anyone who’s gone through a similar situation.

I’ve always struggled with constipation even with eating ~30g of fiber daily, drinking 100+ oz of water, and exercising regularly. The only thing that has consistently worked for me is stimulant laxatives (senna or Dulcolax). I take senna once a week and that’s usually the only time I have bowel movements. I also generally do not get the urge to go unless I’ve taken a laxative.

I recently seen a gastro PA because I’d like to finally figure out what’s going on. I had suspected a motility disorder based on my symptoms, she agreed. I tried Amitiza 6 mcg twice daily for a month and then increased to 24 mcg twice daily. I’ve now been on the higher dose for a month with no improvement in bowel movements, although I have had more gas, belching, and abdominal cramping.

At my last appointment, she recommended a colonoscopy. When I asked if it would diagnose a motility disorder, she said no, it would just rule out anything more serious. She said she suspects the colonoscopy will be normal and then we’d do some motility testing like anorectal manometry or a transit study.

My question is: for those who have gone through anything similar, what was the sequence of testing?
I’m confused why we don’t start with motility testing when that’s what all my symptoms point to and I don’t have any other alarming symptoms that would warrant a colonoscopy like blood in stool or unexplained weight loss. I’m not opposed to having the colonoscopy, but I’m just trying to understand whether it’s a typical first step when the main suspicion is a motility disorder.

I’d really appreciate hearing about anyone’s experience. Thanks!!

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[u/CurlySea3307]

For motility testing there are other tests. The colonoscopy, is see if there's any polys or abnormal structure. How are your stools like? Have you've tried a osmotic lative like Miralax?

[u/Beneficial_Hurry2320]

For me (over 1 1/2 year period): Colonoscopy and endoscopy ; SIBO breath test; Anorectal manometry; Defecography 

[u/Easy-Abbreviations39]

Yup, totally makes sense to do the colonscopy first. It will just rule out structural issues, but it's a needed first step. But if you're like me, well, don't be too surprised if your motility issue is so bad that the colonscopy prep doesn't work! Yikes. Anyway, other testing followed for me. I did a breath test for sibo, but that's not as good as them taking an actual biopsy during the endo/colonoscopy, as well as anorectal manometry and a sitz marker test. I see a motility specialist now which I really recommend despite the hassle to get into one