The treatment for Slow Transit Constipation (STC)

I wanted to make a post about how to treat STC, because I have never seen a comprehensive regimen for treating it anywhere else on the internet, and even the gastroenterologists I've seen have struggled with treatments.

Since my diagnosis I have experimented a great deal with drug combinations (under the careful supervision of a specialist, mind you), and I've developed a routine that works so well my life is basically normal again. This regimen has about a 95% success rate for me; it's far better than any other regimen I've tried.

As with all of my advice, take it in consideration with your gastroenterologist; don't do anything without consulting him/her. The two prescription medications I recommend here are safe when taken together, but many other combinations of drugs that include them are NOT safe, so don't fuck around with drug mixing. These medications are also very expensive and require a specialty prescription to obtain. They are unavailable in some countries, especially prucalopride, which is brand new.

Diet: lots of watery fruits, vegetables, chicken and beef. NO gluten, NO milk, very little cheese. Enormous amounts of water, like twelve glasses a day. Bread products are the worst for my digestion and basically turn into cement in my intestines; cheese is almost as bad. Other grains like sweet potato, white potato, and rice are easier to digest and don't appear to harden in the same way. For some reason, breakfast cereals, chips, and granola are also very difficult to digest even if they're gluten free. I think it has something to do with them being dehydrated / processed.

Exercise: Jog every morning, walk every night. Jump rope and pushups whenever I have the energy. Hiking semi-regularly.

Medications:

• 2mg prucalopride (daily)

• 70mcg [that's micrograms] linaclotide (every other day)

• senna tea (once weekly)

• bisacodyl (once monthly)

Regimen:

Day 1: Upon waking up, take the prucalopride and linaclotide on an empty stomach. Drink 2 glasses of water. Go on a 40-minute jog or a 1-hour walk. Upon return from walk, drink more water. Do not eat any food or drink anything but water. BMs begin about 2.5 hours after taking the medication. An hour after BMs begin, eat 1 apple, 1 banana, 1 handful of mixed nuts, and a daily vitamin, and occasionally a mineral packet in water.

Day 2: This is an off-day. I take only the prucalopride, which isn't super effective by itself, but occasionally causes a BM. I eat breakfast whenever I want and jog or walk if I feel like it.

Rinse and repeat day 1 and 2, except sometimes I'll take senna tea right before bed on the off day, and skip the linaclotide (but still take the prucalopride) the next morning on the on day. The purpose of this is to give my intestines a break from the linaclotide, which I believe (without evidence) is not good for the intestines to take on a regular basis.

Once a month I'll swap the senna for bisacodyl, just to prevent my body from building up any sort of tolerance to either of these. They're stimulant laxatives so they have diminishing returns over time if used too frequently. See my comment for more information on the debate over whether stimulant laxatives are dangerous, and also read what I've written on bisacodyl and senna in this medication guide.