A 30-year-old female presents with a history of chronic constipation. She also complains of rectal pain with defecation. She has a history of multiple episodes of hospitalizations requiring disimpaction. She has progressive bloating worsened by laxatives. Her frequency of bowel movements are only one every few weeks, and to initiate them she must sit for long periods with multiple position adjustments and digital maneuvers to evacuate her rectum. Her current medications include: 8–10 laxatives per day (senna 86 mg) as well as linaclotide (Linzess®).