When I had some painful constipation recently, these Pearls didn't work at all to relieve any of the symptoms - or to keep the constipation away in the first place because, in fact, I was already taking the Pearls before this bout of constipation started. I was even taking 2 Pearls a day instead of the recommended 1 - but still no results. After I finish this box, I won't be ordering another one. I'm going to use a daily stool softener (200 mg/day per my doctor's advice) to try and keep regular instead.