Hi there, Constipation is a problem that needs to be tackled from many sides. Medication wise, if you haven t already you might want to try lactulose, which is very safe for breastfeeding and can be taken for many weeks until your bowels regulates itself. If you find that you get constipated again after stopping it, just restart it again for another week or two. This is quite essential because painful stools naturally makes you hesitant to go, which is a major problem as I will explain below. Other things to do are: 1. I think one of the things that not many people stress on is good bowel practices - which means not holding it in when you need to go, and paying attention to your body more. If possible, schedule a time every morning where you can sit for a while and wait for a bowel movement. Usually after a morning meal or just some warm water will be the best time to try. If that is not your style, then make sure that you check in on yourself often throughout the day, no matter how busy you are. Ask yourself if there is any urge to go, and if at any time there is a small urge, make it a point to just sit and give it some time to try. Holding it in just makes the urge go away, but the stool gets harder and drier at the next effort. 2. Carry on with your fluids and fibre, you are doing great with your efforts. Be careful with fruits, as some fruits like unripe bananas or apples can make some people more constipated. Pears and papayas are quite safe, as are the popular prunes or even dragonfruit. Try green vegetables as well, these are generally quite safe to do. 2. Take care of yourself! Get moving, make sure you have enough exercise to get the bowels moving, and get as much sleep as you can. I understand that having twins can be exhausting, but try to squeeze in whatever activity you can around the house. Remember that you can t care for them well if you yourself are not well. Hope this helps, and all the best to you. Regards to you and the two little ones, Dr. Teh