Hi. Thanks for your query. Noted the history and understood your concerns. Constipation in a end-stage renal disease patient on hemodialysis in spite of laxatives can be due to the following reasons: Less intake of food and liquids as might have been advised due to renal failure can be the major reasons. Gastroparesis of the whole intestinal tract due to raised urea and creatinine affects the motility of the whole intestinal tract. Hard impacted stools due to fecolith formation. All this can be well diagnosed by a X-ray of the abdomen in standing position. When the laxatives do not help a soap and water enema may be the most useful. Sometimes it may be necessary to do a manual evacuation. Continue the laxatives or change over to another stool softener and see the results. Continue diagnosis Add fibers to the diet under the guidance of your Nephrologist and ask for any further things that can be done to relieve the constipation.