Constipation is common, affecting millions of Americans every year . But while occasional constipation or slow gastrointestinal motility may be normal, if it’s chronic and affecting your quality of life, it should be addressed. Often, the problem can be solved by resolving underlying imbalances within the gut microbiome.
Chronic constipation affects up to 27% of the U.S. population, and is most common among women and older adults above age 65 . Constipation is medically defined as having fewer than three bowel movements per week, usually with hard stool that is difficult to pass. However, functional medicine typically defines healthy bowel movements as having a bowel movement at least one per day, ideally 1-3.
Do probiotics help with constipation? In short, yes, they can. And while other treatments like laxatives are fine for short term use, probiotics can actually help address the root cause of chronic constipation for longer lasting change.
Constipation and Gut Dysbiosis
Making better food and lifestyle choices can help some people fix constipation and restore the digestive system. Eliminating processed foods from your diet, adding more high-fiber, whole fruits and vegetables, and drinking plenty of water may be enough to kickstart motility.
However, for others, fiber can make constipation even worse by feeding gut dysbiosis. Gut dysbiosis occurs when harmful microorganisms overpower the good (probiotic) bacteria in your gut, causing gastrointestinal (GI) and often other symptoms like fatigue, brain fog, and mood issues.
Fiber feeds all bacteria in your gut; it doesn’t distinguish between good and bad. So, when you consume a bunch of fiber with an imbalanced gut, symptoms like constipation, abdominal pain, and bloating may actually get worse [3, 4].
Once dysbiosis occurs, a vicious cycle of slow motility leading to further dysbiosis and so on can perpetuate indefinitely. This happens because the waste matter sitting in your digestive tract ferments and produces more harmful bacteria, yeasts, and toxins, creating further constipation. From there, leaky gut may develop, causing additional symptoms like brain fog, eczema, and fatigue.
Fortunately, probiotic therapy can help break this cycle and speed up gut transit time.
How Can Probiotics Help With Constipation?
Probiotics are the good bacteria in your gut that help maintain good digestion, immune function, neurotransmitter production, and more. You’re born with some probiotic bacteria, but many of the probiotics that end up in our digestive system come from our food, and now, supplements. Consuming probiotics can help improve your microbiome balance and even fight the bad bugs, harmful bacteria, yeasts, and parasites [5, 6, 7, 8].
There is a significant and growing body of scientific evidence showing that probiotics can help to improve gut transit time and relieve constipation. Many systematic reviews and meta-analyses show that probiotics:
- Improve gastrointestinal transit time [9, 10, 11, 12]
- Significantly improve stool frequency [9, 10, 11]
- Help with more complete bowel movements 
- Normalize stool consistency 
- Reduce abdominal discomfort 
- Lessen bloating 
- Improve overall quality of life 
In the research so far, there does seem to be a difference in probiotics’ effectiveness in adults and elderly people versus children, with a significant beneficial effect in the former and less conclusive effects for the latter [14, 15, 16, 17]. This may be due to age-related issues like bacterial overgrowth .
Along with improving microbiome status in the gut, probiotics can lower inflammation , reduce and repair damage to the gut lining (leaky gut) [19, 20, 21], and modulate immune system function [22, 23, 24].
Which Probiotics Work for Constipation?
There are several types of probiotics, and some work better for constipation than others. But what works for you also depends on your unique microbiome and underlying root issues.
A meta-analysis of 15 clinical trials showed multi-species probiotics to be more effective in treating constipation than single-species probiotics for improving stool consistency, reducing bloating, and speeding up stool frequency . Irritable bowel syndrome (IBS) patients have had similar success with treating symptoms using multi-species probiotics versus single-species formulas [25, 26].
Our clinical experience backs up this research as well. Many people need more than one category of probiotic to restore balance in their gut environment. Patients who have tried only one type of probiotic in the past and didn’t see any change in their symptoms often report improvements once they begin a multiple category approach. This is why I recommend comprehensive probiotic therapy using the three types of probiotics.
Probiotic Triple Therapy
Probiotic triple therapy allows you to cover all your bases with many different probiotic strains and removes the stress of finding a single effective probiotic for your needs.
Almost all probiotics can be classified into three separate categories . The Probiotic Triple Therapy protocol combines one probiotic supplement from each category for a comprehensive and synergistic approach. The categories are:
- Lactobacillus and bifidobacterium species blends: These multi-species blends combine Lactobacillus and Bifidobacterium species, including Lactobacillus acidophilus, Lactobacillus Plantarum, Lactobacillus casei, Lactobacillus reuteri, Bifidobacterium lactis, Bifidobacterium longum, Bifidobacterium infantis, and others. This category of probiotics has the most research backing it up, with over 500 clinical trials performed.
- Saccharomyces boulardii (a beneficial yeast): This probiotic is not naturally part of the human microbial community, but it does confer health benefits. Saccharomyces Boulardii has the second highest number of studies, over 100 .
- Soil-based probiotics (containing Bacillus species): The final type of probiotic is a category also known as spore-forming bacteria. These bacteria can colonize the gut and guard against pathological organisms .
Step-by-Step Process for Probiotic Use
- Purchase a quality probiotic formula from each category and take all three daily. You can experiment with taking each type at different times during the day, such as one per meal, or taking them all simultaneously. If you’re generally more on the sensitive side when it comes to supplements, or if you notice any side effects after beginning this process, you can take a step back and introduce one probiotic category at a time, monitoring how you feel and giving your body a chance to adjust.
- For 3-4 weeks, monitor your symptoms and note any changes. If you are seeing improvements, maintain the protocol until the improvements have plateaued.
- Once improvements have plateaued, stay on that protocol until your digestive system has adjusted to its new state of balance, about a month. Then, reduce your dosage until you find the minimal effective dose. Stay at that dose.
How Long Do Probiotics Take to Help Constipation?
If you are taking high quality probiotic supplements, improvements may appear between 1-4 weeks. However, we have had patients see dramatic changes in as little as 48 hours.
For example, Rachel struggled with IBS-C for most of her life, often only having a bowel movement every 5-6 days, even with a good diet in place. She also struggled with low mood, eczema, daily headaches, and other symptoms. She tried dozens of different natural treatments with little success. Rachel began Probiotic Triple Therapy, and her constipation improved within 48 hours.
Over time, she noticed that her mood was better too. After the initial period on the protocol, she was able to reduce her dosage and only take type 2 probiotics, Saccharomyces Boulardii.
Improvements like Rachel’s don’t come as easily for everyone, so make sure to try the therapy for at least three weeks to observe any changes. Even small improvements show that probiotics are having a positive effect on your gut microbiome composition.
Additional Treatments for Constipation
Some people find relief from probiotics, but that their constipation symptoms are not completely resolved. Here are some additional treatment options if you need further gut healing:
Prokinetic agents are herbs or drugs that stimulate the gut to move, strengthening the migrating motor complex (MMC) that pushes waste through the colon. Prokinetics aren’t as harsh as some laxatives and gently motivate this complex system of nerves, neurotransmitters, and muscles to increase gut transit time. Prokinetics are also safer for long-term use.
Moving waste through the colon is essential to keep dysbiosis from developing and turning into conditions like SIBO. A meta-analysis found that a prokinetic agent combined with probiotic therapy was the most effective treatment out of 36 different clinical interventions for chronic constipation .
There are many options for prokinetic agents, including both natural and prescription formulas. Motilpro is one natural prokinetic formula we have used with success in our patient population. A meta-analysis found that the drug prucalopride was the most effective prescription prokinetic after 12 weeks of therapy among 17,214 patients in 33 randomized control clinical trials .
Low Fiber Diet
Increasing fiber intake can benefit some with constipation, but often, a high fiber diet is counterproductive for those with a functional constipation issue . As explained above, this is due to the fiber feeding the bad bacteria in the gut, causing fermentation and resulting in symptoms like bloating, gas, and low gut motility.
If a high-fiber diet has not improved your symptoms or has made them worse, a low fiber diet may be a better option while you heal your gut. One clinical trial found that a low fiber diet improved constipation and bloating, increasing stool frequency from once every 3.75 days to once daily .
Many studies have also shown that a low FODMAP diet, designed to remove all fermentable fibers that feed bad gut bacteria, can be helpful for treating IBS, leaky gut, and dysbiosis [34, 35, 36, 37, 38, 39].
If other treatments are not successful, antibiotic (drug) or antimicrobial (natural antibiotic) treatment may be necessary to reduce harmful gut bacteria. The antibiotic drug rifaximin has been shown to eliminate SIBO in 67% of patients .
Herbal antimicrobials are also used in functional medicine, often with similar results and fewer side effects. Herbal antimicrobials, like oil of oregano, have been shown to be effective for SIBO and IBS patients [41, 42].
Herbal antimicrobials are also anti-inflammatory and even anti-depressant in some cases [43, 44]. Whereas antibiotics work mainly against bacteria, herbal antimicrobials are more broad spectrum, killing bacteria, fungi, and parasites .
Still, antimicrobial agents are often only one part of the solution. Many patients need some combination of probiotic therapy, prokinetics, and a low or specific-fiber diet to maintain good gut function.
So, Do Probiotics Help With Constipation?
Gut health is the foundation for overall health, yet for many people, constipation seems like an insurmountable obstacle. So many people receive faulty advice in the conventional medical system to simply eat more fiber and drink more water without looking at the root cause behind low motility.
They may struggle for years to fix the issue with laxatives or other medications, when probiotic therapy may help to gently restore the microbiome with few to no side effects. If you’re looking for guidance on restoring your gut health, schedule a consultation with one of our functional medicine practitioners at the Ruscio Institute for Functional Medicine.