I had a consultation with a health specialist (A certified Physician's Assistant trained at Stanford). She recommended 2 tablespoons of psyllium itself and not the capsules and that has made a difference. I use it in the morning with 3 or 4 prunes in my oatmeal. Also, I had 4 (weekly) sessions of acupuncture. In addition if I am expecting to have some difficulty (surgery this week with two doses of codeine for pain) I will take one capsule of Triphala (made from 3 types of fruit). After more than 8 years of chronic constipation, I no longer have that problem.