Hi there, I understand your frustration, constipation can be a very stubborn problem sometimes. From your description of what you see when you go, the constipation is at a severe stage, and there might be loads more hard stool further up, which is why the oral laxative is taking time to work, or not at all. I agree with the decision to try the enema, and if a full day has passed since your last Fleet enema, you can try another one again. Try to hold it in for as long as you can, preferably the full 5 minutes, in the positions recommended on the packaging, to make sure that it gets as far up as possible and works the best that it can. In the meantime, persist with the oral laxatives, preferably the type that simply softens your stool like lactulose, which can be used for a longer duration. Lactulose can be tapered as needed, starting with maybe 15 mls three times a day, and reducing it once you get better quality of stool. What we are aiming for is completely soft stool that is shaped somewhat like a sausage when coming out, either with a smooth surface or with some cracks on it. Was there an event that triggered off the constipation, or has it been a long standing problem? If it has been a long time, look into your daily habits. Do you go as soon as you feel the urge, or do you tend to hold? Pay attention more to your bodily needs, and make it a point to go as soon as you feel like it. Do you take enough fibre, and keep active? It helps to get your bowels moving regularly, which keeps your stool from sitting in the bowels for too long and getting harder and drier. Hope this helps you, please let me know if you have further questions. Regards, Dr. Teh