Total constipation/nighttime loss of bowel & bladder

[irishherself]

I have had total constipation since Nov. It started without any warning and continues. Sitz marker abnormal as all markers were still present; no obstructions seen.  Given amitiza; works well enough, but have heard others have much better success with it.  Twice during the night I have had loss of bowel and bladder control and did not know it until I awoke the next morning. MRI's of lumbar and thoracic read as nothing of note.  Where do I go from here?  I want a diagnosis, not a bunch of pills thrown at me and a shoulder shrug.  Am seriously worried if this is a neuro problem and it becoming permanent.

[irishherself]

No pain, no bleeding, very soft stools; usually every couple of days.  I used to go every day.  Neuro did an EMG (arms and legs only). Dr. said all seemed to be working well after a quick cursory look at results.  Have not had the full extent of findings told to me on the EMG or thoracic MRI.  No FU for 2 months.

Looked at thoracic MRI yesterday after obtaining a copy.  I have a Chiari (4.9mm) and I believe a retro flexed odontoid.  I don't think the radiologist caught this.  Could this be the source of my problem?  Have a 19 YO niece with a very severe case of Chiari.

Thanks for the quick response.

[DrNavneetMD]

Hi Dear,
I can understand your problem well.
It seems you are having a long standing problem.
When did you have the last bowel movements / past stools?
Is it also painful?
Is there any bleeding?
Neurological conditions such as Parkinson's disease or multiple sclerosis could result in chronic long term constipation, but then response to the drugs would not that be easy.

Lack of good nerve and muscle function in the bowel may also be a cause.
Also, get evaluated for hypothyroidism.

Best