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Probiotics for Constipation: Strains, Benefits, and Dosage

Constipation is a problem with passing stools and will typically affect each and every one of us at some point in our lifetime. For most people, constipation is entirely treatable and should not have serious side effects. However, it can be extremely painful and can significantly impact life quality, potentially leading to various health complications if left untreated. This article considers the potential for probiotics in alleviating constipation and improving overall gut and bowel health.

Constipation and probiotics

Constipation can affect individuals of all ages, from newborn babies to the elderly, not discriminating on gender, race, socioeconomic background, or culture. According to research, constipation costs the U.S. $235 million per year, accounting for an estimated 5.7 million ambulatory visits and being the primary diagnosis for 2.7 million of those visits.

The multifaceted nature of constipation can make it difficult to manage. Over-the-counter remedies such as stool softeners or laxatives for constipation are often met with mixed success, so it is not surprising that people are looking to alternative methods for natural constipation relief. Probiotics are beneficial bacteria that can improve gut health and potentially alleviate the symptoms of, and reduce the risk for, constipation.

What is constipation?

Constipation is a very common problem of the digestive system associated with gastrointestinal symptoms, such as stomach pain and bloating, alongside the inability to pass stools.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, constipation is a condition in which you may have fewer than three bowel movements per week; stools that are hard, dry, or lumpy; stools that are difficult or painful to pass; or a feeling that not all stool has passed. When the symptoms of constipation last for over one month, constipation is considered chronic.

According to research, dietary issues that cause constipation include inadequate fiber intake, inadequate water intake, and overuse of coffee, tea, or alcohol, alongside reduced levels of exercise. Other more complex associated factors may be found in the form of pre-existing medical conditions or diseases. Anatomical factors are to be considered, as constipation is more likely in people with anal fissures or hemorrhoids, to name but a few. Celiac disease, cow milk protein allergy, and inflammatory bowel disease could also be contributing factors that lead to constipation.

Medications contributing to constipation include antidepressants, lead, iron, calcium channel blockers, and nonsteroidal anti-inflammatory drugs. Metabolic and endocrinologic conditions that may lead to constipation include diabetes mellitus, cystic fibrosis, and hypo or hyperthyroidism, and certain neurological disorders such as spina bifida, Parkinson’s disease, or multiple sclerosis may also lead to problems with constipation.

What are probiotics?

According to the World Health Organisation, the term probiotic is a relatively new word meaning 'for life,' referring to bacteria associated with beneficial effects for humans and animals. More specifically, the WHO defines probiotics as “live microorganisms which when administered in adequate amounts confer a health benefit on the host.”

Probiotics may enhance your gut microbiome, working alongside existing gut microbiota (beneficial bacteria in your digestive tract) to regulate bodily functions and processes, such as digestion, heart health, immune function, and inflammation.

The benefits of using probiotics for constipation are multi-faceted, helping to alleviate symptoms while providing additional health benefits throughout the body. Probiotics work within the gut to:

Mechanisms of action include restoration of the gut flora balance, enhancing gut barrier function, modulating immune response, reducing gut transit time, and aiding digestion and nutrient absorption. According to some research, probiotics also have antimicrobial effects and detoxifying properties. Effective maintenance and promotion of gut health is essential in human health since 70% of the human immune system cells are located in the gut, denoting a clear role for probiotics in human health.

How do probiotics help with constipation?

Probiotics have been shown to improve or restore gut microbiota, or gut flora, which in turn has been linked to improved health, having versatile roles in the process of digestion. Maintaining a healthy gut bacteria balance is essential in promoting a healthy digestive system.

Bacteria in your gut help break down some complex carbohydrates and dietary fibers that you would be unable to break down on your own. Probiotics can influence the production and activity of digestive enzymes, assisting the body in breaking down and absorbing nutrients from food sources. Encouraging this process through the use of probiotic supplements can help alleviate the symptoms of constipation.

The gut microbiota is also an important component in the exchange of information between the gut and the brain, which is described as the gut-brain axis, a complex communication network that we are in the process of understanding for its role in both gut and brain health.

Ensuring microbiome diversity may positively influence the effectiveness of such a network, and probiotic supplementation is one way we can introduce new strains and increase our gut microbiome diversity. The use of probiotics for improved digestive health is well-researched and remains one of the key benefits of the use of probiotics.

Numerous digestive health benefits have been identified through medical research, such as the alleviation of certain types of diarrhea, constipation, and symptoms associated with inflammatory diseases.

In one meta-analysis of 15 randomized controlled trials, consumption of probiotics substantially reduced gastrointestinal transit, improved stool consistency, and increased stool frequency and were concluded to be a safe and natural agent for the alleviation of functional constipation in adults. Another debate surrounds the use of prebiotics vs. probiotics, with much research suggesting that a combination of both probiotics and prebiotics increases probiotic effectiveness not only for their applications in gut health but also colon and intestinal health.

Which probiotic strain is best for constipation?

Although there is insufficient evidence to recommend specific strains of probiotics, Lactobacillus spp. and Bifidobacterium spp. strains have demonstrated promising results for their use in alleviating constipation across clinical trials. In a randomized, double-blind controlled trial, two combinations of Lactobacillus spp. and Bifidobacterium spp. strains were effective in improving the symptoms of functional constipation. They did this by increasing the weekly frequency of evacuation and stool quality and were deemed safe for this use.

In one integrative review considering the effects and the potential mechanism of action of prebiotics, probiotics, and synbiotics on constipation-associated gastrointestinal symptoms, Lactobacillus casei Shirota (L. casei Shirota) improved stool consistency and defecation frequency, while Bifidobacterium lactis strain increased defecation frequency.

Another animal study yields a new perspective on the clinical use of probiotics to improve constipation symptoms. The authors conclude that combining five Lactobacillus spp. strains with different mechanisms for the alleviation of constipation may be more effective than using one strain. However, probiotic-related mechanisms for the alleviation of constipation are still unknown.

How to use probiotics for constipation?

Probiotics can be found in several food sources, such as yogurt, cottage cheese, and various fermented foods, but they can also be introduced into the body using supplements taken in a variety of ways to suit your individual needs or preferences, including:

Through a combination of medical advice, appropriate choice of strain, appropriate dosage, and regimen, the use of probiotics may be effectively introduced for the management of constipation alongside alternative constipation treatments, such as a balanced diet rich in fiber, adequate hydration, and regular physical activity.

Monitor your symptoms from the onset of supplementation, noting any changes to your stool frequency, consistency, and abdominal discomfort throughout. For chronic constipation, it may be necessary to consider long-term probiotic use.

Dosage

The World Gastroenterology Organisation (WGO) notes that the optimal dose of probiotics depends on the strain, product, and indication for use. The WGO guidelines include a summary of evidence on specific probiotic strains used in studies for specific gastrointestinal endpoints, for which probiotic dosage recommendations can be found. However, it is always recommended to consult a healthcare professional for optimum dosage recommendations.

Side effects

Probiotics are usually well tolerated in healthy people and are considered a safe and effective adjunct for the improvement of health in many instances. However, mild side effects could include:

  • Abdominal discomfort
  • Gas and bloating
  • Diarrhea
  • Constipation
  • Stomach pain
  • Allergic reactions, rash, itching, or swelling
  • Interactions with some medications

There is a chance that the bacteria or yeast in probiotics may sometimes cause infection in people who have a very weak immune system due to chronic illness, the use of immunosuppressant drugs, and infants who've been born prematurely.

It is always advised to consult a healthcare professional before starting a new supplement, considering probiotic safety in the context of underlying conditions and existing medications.

How to choose the best probiotics for constipation

Choosing the best probiotics specifically for use in constipation should be based on a number of factors.

Strain of probiotic

Lactobacillus spp. and Bifidobacterium spp. strains have demonstrated promising results for their use in alleviating constipation across clinical trials, so it would be wise to choose a supplement that contains these specific strains of probiotics for best results.

  • Bifidobacterium lactis (e.g., B. lactis HN019, B. lactis BB-12)
  • Lactobacillus rhamnosus
  • Lactobacillus acidophilus
  • Lactobacillus casei
  • Bifidobacterium longum

Colony-forming units

Probiotics are measured in colony-forming units (CFU), indicating the number of viable bacteria. A higher level of CFUs is often considered an indication of product quality and probiotics effectiveness. The average CFU count in probiotics is typically within the range of 1–10 billion per serving.

However, a higher CFU count does not necessarily improve the product’s health effects. CFUs are just one consideration when choosing the best product for constipation. For best results, your choice should reflect findings from clinical research studies and your healthcare provider's advice.

Look for products labeled with the number of CFU at the end of the product’s shelf life, not at the time of manufacture, as these can die during ongoing shelf life.

Quality of product

The quality of a specific probiotic product can be based on numerous factors and influences, like considerations of compliance, function, process, and product composition. First and foremost, look for a product that has been tested and has been proven to work specifically for constipation, backed by medical research. It may pay to opt for a more reputable brand that you can be sure will have done the testing appropriately in an accredited laboratory, as probiotics are not always regulated in the same way. Identifying products that have used third-party testing guarantees quality standards.

The probiotic product should be manufactured using Good Manufacturing Practices (GMP) with high-quality and transparent ingredients.

Always check the label of probiotic supplements for storage recommendations, as some products may require refrigeration.

Enteric coating

Choosing a product with an enteric coating may improve its effectiveness. Enteric coating has been used in medications for years to prevent the degradation of active ingredients by stomach acid. Instead, the product reaches the intestine for better absorption.

Research considers that enteric coating could protect probiotics from the acidic gastric environment and enhance product bioactivity.

Inclusion of prebiotics

Some probiotics are considered synbiotics, meaning they are a mixture of both probiotics and prebiotics, which may be a potential tool for the management of constipation. Some supplements contain prebiotics in the form of fiber, whilst others encourage the growth of probiotic bacteria.

Editor's top picks

Below is a list of three specific probiotic supplements that may help to alleviate the symptoms of constipation.

Unbloat comm block
  • 25 billion CFUs per serving
  • 7 different probiotic strains
  • The formula includes digestive enzymes and prebiotic fibers

Self-proclaimed "daily gut cleanse," this Unbloat probiotic is designed specifically to counteract bloating and improve gut health. Having around 25 billion CFUs per serving, this probiotic product offers to improve microbiome diversity significantly, combining seven different probiotic strains — L. casei, B. lactis, L. plantarum, L. acidophilus, L. rhamnosus, B. longum, and B. bifidum.

Yourbiology probiotics
  • 40 billion CFUs per serving
  • 4 different probiotic strains
  • Suitable for vegetarians

Suitable for vegetarians, Yourbiology contains four specific strains of bacteria: Lactobacillus acidophilus, Bifidobacterium lactis, Lactobacillus plantarum, and Lacticaseibacillus paracasei. These strains are naturally present in the human digestive tract and may potentially have a positive effect on gut health. This particular product also contains fructooligosaccharides (FOS), a prebiotic in the form of fiber that may help to alleviate constipation.

ritual synbiotic commercial
  • 11 billion CFUs per serving
  • 2 different probiotic strains
  • The formula also includes prebiotics and postbiotics

The Ritual probiotic supplements boast many benefits that may potentially improve gut health, including improved gut health, enhanced digestive function, supported immune system, and increased nutrient absorption. Consisting of two probiotic strains — Lactobacillus rhamnosus and Bifidobacterium animalis — and containing 11 billion CFUs, Ritual probiotics are often considered one of the best for constipation relief.

Further information

One systematic review and meta-analysis of randomized controlled trials sought to investigate the effect of probiotics on gut transit time, stool output, and constipation symptoms in adults with functional constipation. It concluded that probiotics may improve gut transit time, stool frequency, and stool consistency, with subgroup analysis indicating beneficial effects of B. lactis in particular.

A randomized placebo-controlled study of 280 people with Parkinson's disease found that the use of a multistrain probiotics treatment was effective for constipation as a side effect of the disease. However, further studies are needed to investigate the long-term efficacy and safety of probiotics use in this way, as well as their mechanisms of action.

A further meta-analysis and systematic review of randomized controlled trials analyzed a total of 21 studies comprising 2,656 participants, finding that supplementation with products containing Lactobacillus spp. or Bifidobacterium spp. species increases stool frequency and reduces intestinal transit time in constipated adults.

A number of studies have confirmed the relationship between constipation and gut microbiota. Lactobacillus acidophilus LA11-Onlly, Lacticaseibacillus rhamnosus LR22, Limosilactobacillus reuteri LE16, Lactiplantibacillus plantarum LP-Onlly, and Bifidobacterium animalis subsp. lactis BI516 were administered in an animal study, finding a combination of strains most effective for relieving symptoms of constipation.

Bottom line

Probiotics are under continued investigation for their potential positive impact on multiple health outcomes, with many research studies suggesting they may have a beneficial impact on the symptoms of constipation. Supplementation with probiotics could potentially be included as part of a holistic treatment plan for constipation, alongside a balanced diet rich in fiber, adequate hydration, and regular physical activity.

It is always advised to obtain a clinical assessment from a healthcare professional before starting any new supplement regime, especially in the context of severe, painful, or chronic constipation associated with pre-existing conditions, diseases, or regular medication intake. Seek immediate medical assistance if your constipation is associated with rectal bleeding, blood in your stool, severe abdominal or back pain, fever, vomiting, or weight loss.

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