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Pushing with hand to poop?

I am 22 year old female. I have always had chronic constipation even though I exercises daily, eat a balanced diet, and take miralax.

In order for me to poop I need to push on perineum with my finger, sometimes push between the beginning of butt crack and top of anus.

Is this normal- what could be the cause?
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973741 tn?1342342773
Well, no.  I wouldn't call having to push your own poop out normal.  Miralax probably is best used in the short term.  The literature states up to 6 months max.  I always worry about rebound constipation but some do use it chronically like you describe.  One of my kids has chronic constipation.  He's been in the hospital emergency room because he was so backed up it was acting like a bowel blockage!  They told him then to drink one cup of grape juice a day.  He does, it works well for him.  He also had a hospital grade enema.  Have you used Fleet or an enema?  It's not hard to do and may get things moving.  Sometimes weakened pelvic floor muscles can be the cause but there are a whole host of reasons.  I'd see a gastroenterologist to begin trying to figure out why.  My son has worked with a GI doc and for people like him, they have injected botox into the gut which helps.  He's not done that yet.  But he does use a good pro biotic which really helps too.  https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253  How long has this been going on?
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