Every once in a while, I have patients come into the pharmacy asking about probiotics for constipation. There is a lot of information out there regarding the use of probiotics and their effect on diarrhea, but many may not consider using probiotics for constipation, especially with all of the over-the-counter treatments available.
But, when you think about it, it makes sense that patients would ask about probiotics for difficulty passing stool – probiotics are one of the most common supplements for gut health, and if they help with regularity in one direction, why wouldn’t they help in the other?
And if conventional, over the counter drugs aren’t working, or if they give someone unpleasant side effects (or if you don’t like taking drugs, which as a pharmacist I can understand), then it makes sense to ask about probiotics.
The good news is that there is some decent scientific evidence that probiotics can help with constipation.
How can probiotics help with constipation?
You may be thinking, if probiotics help with diarrhea, how can it also help with constipation symptoms? Some studies have found that a few probiotic strains can increase stool consistency and frequency in some people. Let’s dig in:
Researchers think that probiotics might help with constipation symptoms through several mechanisms. First, they might change the gut normal flora to relieve constipation, they might enhance the gut’s motility, they can possibly affect the gut’s ability to produce short chain-fatty acids which influence bowel movements as mentioned in this study, and alter the gut’s transit time. As stated in this article, “Intake of probiotics can regulate the fecal microbiota, increase the levels of organic acids to promote intestinal peristalsis, shorten the colon operation time, and lessen symptoms of constipation.”
Digging into a specific, well-designed research study into probiotics and constipation
A study was done to see if a specific probiotic, Lactiplantibacillus plantarum P9 could help, and was published in a prestigious journal, Pharmacological Research. Before we dive in, one note: Lactiplantibacillus plantarum used to be known as Lactobacillus plantarum; it was reclassified in 2023, so you may see some supplements referring to Lactobacillus plantarum – don’t worry, it’s now Lactiplantibacillus plantarum.
In the study:
- 163 people with chronic constipation were either given the L. plantarum P9 probiotic or a placebo for 42 days. A placebo is a sugar pill, which means the researchers could compare the patients who took the L. plantarum P9 vs. people who thought that they were taking it to see if there was actually any difference in how the felt and their bowel movements.
- Those taking the P9 had more regular bowel movements and were less worried about their constipation than those on the placebo.
- The P9 group had an increase in good gut bacteria and a decrease in some not-so-beneficial ones.
- The study also noticed links between certain bacteria and bowel movement frequency and concerns.
- There were positive changes in the type of substances produced by gut microbes in those taking P9, hinting at a healthier gut environment. Basically some good short-chain fatty acids and other markers that indicated a possibly healthier gut barrier..
In essence, the P9 probiotic not only appeared to relieve constipation but also positively changed the composition and function of the gut’s microorganisms. This supports the idea that probiotics like P9 could be a strategy for managing chronic constipation. I really like how the researchers used what is considered the gold standard for this kind of research, the double blind placebo where some patients got the bacteria and others thought that they were getting it but only got a sugar pill.
Which probiotics are likely helpful for constipation?
So, the study we just summarized used a version of Lactiplantibacillus plantarum, previously known as Lactobacillus plantarum, to help reduce constipation. Another probiotic that has been shown to help reduce the impact of constipation are Bifidobacterium lactis probiotics. Both of these are easily available in supplements.
How long does it take to work?
Now you might be thinking, if I decide to take probiotics to help alleviate constipation, how long is it going to take? Like many other conditions probiotics help with it really is going to depend on the person. It can take anywhere from a few days to a few weeks for the probiotics supplement to help with the symptoms of constipation. Advice I often give to patients is to be patient and give it several weeks. OF COURSE, if you are having serious health problems see your doctor right away!
Now that we have gone over how probiotics can help with constipation symptoms, we can take a look at what constipation is and what causes it.
What is Constipation?
Constipation is a common digestive system issue described as infrequent or difficulty passing stools. While it feels different for each person, doctors generally say that less than 3 bowel movements per week would be considered constipation. There are a few symptoms that are associated with constipation including:
- Infrequent bowel movements
- Hard or lumpy stools
- Difficulty or straining
- A feeling of incomplete evacuation
- Pain or discomfort in the abdomen
What are the Causes?
- Dietary factors like lack of fiber, a sudden change in diet, and inadequate fluid intake.
- A sedentary lifestyle.
- Some medications can contribute or cause constipation like iron supplements, pain killers, antacids, and some antipsychotics.
- Some medical conditions can lead to constipation like diabetes, thyroid disorders, Parkinson’s disease, multiple sclerosis, and some others.
- Hormonal changes in pregnancy
- Ignoring the urge to have a bowel movement.
What can You do in Addition to Probiotics to Help Alleviate Constipation?
- Increase fiber intake, more fruit and vegetables specifically prunes.
- Increase fluid intake.
- Increase physical activity.
- Addressing the underlying cause.
Probiotics are safe in most patients, but it is always important to check in with your healthcare provider if you have any questions or concerns. Although probiotics may be helpful in assisting with the symptoms of constipation, they may not be a good replacement for evidence-based treatments. Also keep in mind if someone is experiencing severe or chronic constipation, especially if you are having other symptoms like abdominal pain, weight loss, or blood in the stool, you should consult with your doctor.
Some of my other articles on gut health
I write a lot about gut health – believe it or not, there are a lot of questions you get at the pharmacy counter about it! Somewhat related to this topic is how helpful bacteria and yeast supplements can impact diarrhea. Maybe not the same question, but one that I’ve gotten at the pharmacy – do probiotics make you pee more. Another important topic is how many active bacteria you are getting in your supplement – which I cover in my article on CFUs. Once again, always consult with your doctor or a healthcare provider before trying to self treat a serious condition or before adding a new supplement to your routine.