In the “If it’s not one thing [diarrhea], it’s another [constipation]” tradition, hard-packed stools and straining during bowel movements—sometimes to the point of causing hemorrhoids—plague many PWAs. The four-word solution? Water, fiber, magnesium, exercise.

Increasing fluid intake is a must. A simple formula to follow: Divide your weight in pounds in half, and then drink that number of ounces of fluids every day. At the same time, make a point of eating very regularly while increasing the amount of fiber in your diet. A mostly whole-foods diet—including unrefined grains such as brown rice and whole-wheat products, along with baskets of fruits and vegetables—is the best beginning.

If that doesn’t do the trick, you should try supplements: One or two tablespoons of a commonly available soluble fiber such as Metamucil (which contains psyllium seed) or Citrucel (which contains fiber from citrus), mixed in a glass of water, two to three times per day. It’s best to take such products at the end of a meal to give them a chance to mix with the food. Taken before eating, they can create a sensation of fullness that may decrease your food intake. Taking them between meals can result in a gelatinous mass at one bowel movement, and the same old hard stools the rest of the time. Always increase fiber intake slowly. Starting out with too much can cause gas.

Magnesium deficiency, which is very common in HIV positive people, often constipates. Taking supplemental magnesium (in doses of 500 to 1,000 mg per day—and work up slowly) can be very useful. And last but not least, daily moderate exercise—important for many health reasons—can help to eliminate constipation by stimulating bowel movements.