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You may need a manual evacuation if you have stool impaction.
Ideally, you should consult a gastroenterologist who can perform the following investigations which are the mainstay of the evaluation and which will give a true perspective of the cause;
1) Blood investigations do give the clue. A complete blood count, biochemical profile, serum calcium, blood glucose, and thyroid function tests are routinely recommended in the evaluation of patients with constipation.
2) Depending on these blood results further blood work is done; serum protein electrophoresis, urine porphyrins, serum parathyroid hormone, and serum cortisol levels, may be done to identify or rule out myeloma, porphyria, hyperparathyroidism, and Addison's disease.
3) Barium enema or barium meal with follow-through study
4) Colonic transit time; can provide a better understanding of the rate of stool movement through the colon.
5) Other investigations like Anorectal manometry, balloon expulsion test, Defecography, etc.
6) Colonoscopy / sigmoidoscopy
Following measures can be helpful;
1) Increased fluids
2) Prune juice and dried plums
3) Increased fiber; preparation like Benefiber can be tried.
4) An herbal tea, "Smooth Move," has been found to have a good result in moving the bowel.
5) Toilet after meals; Toileting 15 to 30 minutes after eating makes use of the gastrocolic reflex. The gastrocolic reflex results in propagating spikes in the colon and rectum within half an hour after a meal. When we eat, our stomach distends and this sends reflex signals to the large intestines (colon) facilitating their movements. If one utilizes the next half hour of a meal, for the toilet, the stool elimination time is decreased.
6) Increase in exercise
7) Stimulant laxatives stimulate intestinal motility and increase intestinal secretion. They are anthraquinones (cascara, aloe, and senna) and diphenyl methanes (bisacodyl, sodium picosulfate, phenolphthalein). These may be avoided more than twice a week, though they are effective but can be harmful in the long term.
8) Avoidance of stress
9) Wheat bran, 20 gms per day can decrease the rectal transit time
11) Fruits (especially dried fruits)
12) Cereals like whole wheat, bran, or oatmeal
14) Grainy bread, such as whole wheat, rye, or pumpernickel
15) Legumes, such as chickpeas, baked beans, and lima beans
16) You can try ground flaxseed sprinkled on salads, cooked vegetables, and cereals.
Foods that cause constipation and should be avoided are;
Meat / Red meat
Chips, cookies, and pizza
Foods that contain white flour
Junk food or fast food
I wish your symptoms resolve soon.
I would be happy to assist you further if you need any more information.
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