My doctor recommended getting more fiber for my constipation, but it’s not helping. What can I do?

Getting more fiber from plant foods (especially pears, apples and sweet potatoes—all with skins on—and cooked greens) will usually increase the frequency and comfort of bowel movements, but not for everyone. A form of constipation known as slow-transit constipation (STC) occurs when the intestinal muscles contract less often and with less force than normal. Some patients with STC improve when they get more fiber, but others will still need laxatives or other treatments. If you have constipation that hasn’t responded to dietary changes, ask your doctor whether you might have STC.

It’s also important to take medication into account. Many prescription and over-the-counter drugs and supplements can cause constipation as a side effect. Psychiatric medications, including tricyclic antidepressants, such as imipramine (Tofranil) and amitriptyline (Elavil), are notorious for causing constipation. If a new medication is causing constipation, ask your doctor if you can get by with a lower dose or switch to a different drug.

Eating prunes can help, too. Prunes are high in fiber, but the main benefit comes from sorbitol, a sugar that draws water into the intestine. Two servings of prunes (about 10 fruits) contain 12 g of sorbitol and 8 ounces of juice has about 15 g. If you don’t like prunes, consider trying rhubarb, artichokes and/or peaches—all of which promote regular bowel movements.

Drinking more water and getting more exercise help keep stools soft and intestinal muscles active, too.

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