Choosing a Natural Laxative: What’s Right for Your Gut Problem? - Dr. Michael Ruscio, DC

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Choosing a Natural Laxative: What’s Right for Your Gut Problem?

How to Use Natural Laxatives and Other Corrective Treatments for Constipation

Key Takeaways:

  • Natural laxatives work in various ways that include stimulating your gut wall, drawing water into the bowel, and bulking the stool.
  • Examples of natural laxatives include Senna, magnesium, and psyllium.
  • Natural laxatives are typically a temporary fix, while correcting underlying gut microbe imbalances with probiotics can help constipation from reoccurring.
  • Antimicrobials can also play a part in correcting constipation caused by an unhealthy microbiome such as in methane-dominant SIBO.
  • A healthy diet that provides enough fiber and hydration is also key to keeping bowels regular and preventing constipation.

When your bowels are acting sluggish it can often affect your whole well-being.

Fortunately, there are several natural laxatives that relieve constipation and restore regularity, at least temporarily.

Natural laxatives can seem like an attractive option, given synthetic versions can be harsh and create dependency. 

However, it’s worth remembering that natural doesn’t always mean safer. Some natural laxatives like Senna and cascara should only be used short-term and with caution, as they too can create dependency.

Fortunately, there are other natural laxatives, like psyllium and magnesium, that are much safer for long-term use, and also have other health benefits. We’ll run through some of these options below, while also considering constipation in a broader context.

More specifically, what might be causing your constipation and wider digestive health issues? And what corrective treatments could get your digestive system in better shape over the longer term?

First, what is constipation and why is it a problem?

Defining Constipation

Everyone is different, and you will know what feels right for you in terms of how many times you go to the bathroom.

However as a guide, constipation is usually defined as [1]:

  • Having a bowel movement less than three times a week
  • Stools that are hard, lumpy, and/or uncomfortable to pass
  • A feeling that not all the stool has been passed

Constipation can be primary (also known as functional or idiopathic), which means it stems directly from issues such as slow gut transit, or problems with nerves or muscles in the pelvic floor.



Constipation can be secondary which means it happens as a side effect of other issues, such as hypothyroidism, diabetes, or irritable bowel syndrome. The use of certain medications — like opioids, some antihistamines, and antidepressants — can also cause constipation.

More than Just a Nuisance

The symptoms of constipation include uncomfortable bloating and gas, but there may also be more serious consequences that include [2]: 

  • Piles (hemorrhoids)
  • Impaction (when stools get stuck inside the bowel forming a blockage)
  • Rectal prolapse (when part of the rectum slips outside of the anus)
  • Anal fissures (small tears around the anus)

Your stool is also the vehicle for toxin removal from your body. So when you are constipated and wastes stay longer in the gut than they should, the risk of absorbing toxins that should be exiting your body increases. As I discuss in Healthy Gut, Healthy You, this can create inflammation, disrupt hormone balance, and affect your immune system function.

Natural Laxatives for Symptomatic Relief

There are various natural laxatives that can work well at helping you go to the bathroom in acute constipation. But not all laxatives are created equal, and different types have different actions. The way that they work might influence which one you choose, as some are not appropriate for long-term use and most don’t fix the underlying cause of constipation. 

Let’s look at them one by one:

Osmotic Laxatives 

Osmotic laxatives can work quickly and efficiently by drawing water into the intestine to help soften the stool. Magnesium hydroxide (Milk of Magnesia), magnesium oxide, and magnesium citrate are “saline osmotics” which, while effective, may temporarily unbalance blood chemistry, especially if you go straight for a high dose, which can be a problem for people with poor kidney functions [3].

Other common osmotic laxatives include lactulose and sorbitol, which occur naturally in small amounts in fruit and dairy products [4]. Higher intakes stimulate gut bacteria growth, which may cause wind and bloating along with the laxative effect.

Either type of osmotic laxative can cause diarrhea if the dosage is too high, which is the most common side effect of these laxatives [5, 6, 7].

Magnesium is the best bet for most people when it comes to osmotic laxatives, as it has other health benefits that include improved insulin resistance [8] and lowered risk of cardiovascular diseases, including stroke [9].

It’s best to start magnesium low and slow, then to increase your dose gradually until you have loose bowel movements. Once at this point, you can cut back by one tablet/capsule. Taking magnesium at night is best to promote a morning bowel movement.

Stimulant Laxatives

Stimulant laxatives, also known as contact laxatives, stimulate bowel movements by acting directly on the intestinal wall and making it contract.

Senna and cascara are well-known herbal laxatives where the stimulant effect comes from the active ingredient anthraquinones. While effective, Senna and cascara can be a little harsh, so you’ll want to go easy on the dosage to avoid stomach cramps. 

Using too often or for too long can also desensitize your bowel to the action of Senna, with the risk of losing their normal activity that can create a dependency on laxatives, or even constipation (10).

Bulk-Formers

Bulking laxatives are soluble fiber based and work by forming a gel (mucilage) that bulks out the stool and encourages the wave-like peristaltic contractions that push food along the digestive tract [5, 11, 12]. 

Psyllium (ispaghula) is the best-known natural bulking laxative, made from the seed husks of the botanical Plantago ovata). Methylcellulose is another option and is sold over-the-counter under a variety of names. Bulking laxatives tend to have a gentler action and can take a few days to ease constipation.

Psyllium (Metamucil) has other health benefits, which include reducing blood cholesterol levels in people with elevated cholesterol [13, 14] and lowering blood glucose levels in people with type 2 diabetes [15]. 

When you are using bulk-forming laxatives, it’s important to drink plenty of water to keep your stool soft enough to pass. 

Herbal Prokinetics / Promotility Agents

Prokinetics are agents that help to increase gastrointestinal motility — or how quickly and efficiently food moves through the digestive tract. Synthetic prokinetics (pharmaceutical drugs) generally work by either stimulating or suppressing neurotransmitters in order to encourage peristalsis and improve motility. However, they have been known to have side effects such as cardiac problems [16, 17].

Natural prokinetic agents include Iberogast, MotilPro, and triphala. They are gentler but can still work well.

For example, triphala (a blend of Ayurvedic herbal medicines) improved the frequency and consistency of bowel movements in one clinical trial, so it may be a good choice for constipation [18]. It is also credited with many other health benefits, such as bolstering against stress, being anti-inflammatory, and helping gut bacteria balance, but these claims don’t have many good human studies to support them.

Though we are focusing on natural laxatives in this blog, it’s worth giving low-dose naltrexone a brief mention, as it can be an effective prokinetic. Naltrexone is a pharmaceutical medication used for opioid and alcohol use disorders, but only very low doses are needed for its prokinetic function (about a sixth of the normal dose), which makes it safer and better tolerated than other synthetic prokinetics. 

You can listen to a podcast where I discuss the wider uses of low-dose naltrexone with Dr. Leonard Weinstock here

Pros and Cons of Natural Laxatives

For an at-a-glance to the pros and cons of common natural laxatives see the table below:

Natural LaxativeProsCons
Magnesium hydroxide /oxide/ citrate (osmotic laxative)Effective and fast-acting. Magnesium is also an important mineral that helps with nerve, muscle, and cardiovascular function, as well as glucose metabolism.Not safe for people with poor kidney function. High doses may cause diarrhea
Lactulose (osmotic laxative)As well as effectively softening stool, lactulose is also considered a prebiotic (stimulates gut bacteria growth).Can cause wind and bloating for people with a sensitive gut
Senna (stimulant)Quick and effective (works overnight)Can cause gut cramps. If you take too often, you could become dependent on a stimulant laxative to have a bowel movement.
Psyllium (bulk-former)Generally quite gentle acting and less likely than some laxatives to cause stomach distressCan take a few days to work. Can worsen constipation if you don’t stay well hydrated while using
Triphala (prokinetic)May be good for gut health and health in general due to high content of anti-inflammatory and antioxidant compoundsFormulations/dosage can vary and high-quality human studies on triphala are limited. 

Diet for Constipation

While laxatives have their place, the initial recommendation for chronic constipation is to make diet and lifestyle modifications such as increasing dietary fiber intake and drinking water.

Increased fiber (like psyllium) in the diet is associated with more frequent stools in constipated patients [19].

Choosing a Natural Laxative: What’s Right for Your Gut Problem? - high%20fiber%20foods Landscape L

However, your fiber intake needs to be matched with optimal fluid intake to keep poop soft and easy to pass. In one study a daily intake of 25 grams of fiber increased stool frequency in patients with chronic primary constipation, but this effect was significantly enhanced by increasing fluid intake to 1.5–2 liters (approximately 6–8 eight-ounce glasses) a day [20].

Some examples of specific foods that have been studied and can be incorporated into the diet to improve constipation include: 

  • Prunes and prune juice [5 ,21, 22]
  • Kiwifruit [5]
  • Mango [5]
  • Figs [5]
  • Flaxseed [4]
  • Dried plums [23]

Other high fiber foods such as fruits, vegetables, legumes, nuts, seeds, pulses (legumes), whole grains, oats, rye, and quinoa can be incorporated to increase overall soluble and insoluble fiber intake [24, 25]. 

Additionally, higher dietary magnesium intake is associated with less constipation [26]. 

Therefore, foods that are high in both fiber and magnesium, such as leafy greens, chia seeds, pumpkin seeds, legumes, and nuts may also help improve regularity [27, 28].

When Your Gut is Sensitive

Choosing a Natural Laxative: What’s Right for Your Gut Problem? - how%20to%20get%20more%20fiber%20with%20a%20sensitive%20gut Landscape L

Unfortunately some people with gut sensitivities can react badly to either too much fiber or certain types of fiber, so in this case, increasing fiber needs to be done slowly and carefully. Ironically people with IBS-C (constipation-predominant irritable bowel syndrome) are among this group too [12].

The issue if you are fiber or prebiotic-sensitive is usually that you have an overgrowth of bacteria that ferment fiber in the colon, causing excess gas, bloating, and discomfort. Or you may just be over-sensitive to the effects of these bacteria.

Either way, I usually recommend to any patient with gut sensitivities such as bloating, IBS, and SIBO (small intestine bacterial overgrowth) to be cautious with fiber when first making improvements to their diet. Ultimately, you’ll need to find the levels of potentially symptom-triggering prebiotics fibers and carbs that suit you.

For many gut issues, a Paleo diet (with enough fiber to keep the gut healthy but not too much to trigger bloating) works well. For more significant gut issues, i.e. where you are extremely fiber and prebiotic sensitive, you may want to try a low FODMAP diet. 

A low FODMAP diet helps you to identify the fermentable and prebiotic fibers that trigger the worst symptoms for you.

Probiotics for Constipation

While a healthy diet, fluid, and the occasional use of laxatives can help with most cases of constipation, addressing the underlying issue is important to prevent constipation from recurring.

This is where a probiotic supplement can be particularly useful.

Several studies have shown probiotics may be a help with constipation because of their ability to correct dysbiosis, bacterial overgrowth, and inflammation, and to induce beneficial changes in the gut microbiota and gut transit time [29]. 

  • One review of clinical trials concluded that probiotics significantly increased stool frequency by an average of 1.3 bowel movements per week. Compared with placebo, patients on probiotics experienced a shorter gut transit time by an average of 12 hours [30].
  • In patients with mild, intermittent constipation, using a soil-based probiotic was also associated with more complete bowel movements, and less abdominal discomfort compared with placebo [31].
  • A study that tested a Lactobacillus-based probiotic in people with chronic constipation, found that it benefited constipation via a reduction in methane production (constipation is a particular feature of methane-dominant SIBO) [32]

Probiotics can also be of benefit alongside laxatives to mitigate some of their potentially harmful effects on the gut microbiome. One study found that probiotics helped prevent a negative shift in gut bacteria caused by the laxative magnesium oxide [29]. Probiotics normalize bowel movements without any strong laxative effect, so you don’t have to worry about taking the two together. In fact, it’s optimal to do so!

What’s the Best Probiotic?

No one probiotic can be picked out as being better than another for constipation or other gut health issues, and in fact, research seems to support a mix-and-match approach. 

For example, multistrain probiotics were found to perform better in a meta-analysis of studies using probiotics to treat constipation [33]. And when mixtures of several probiotics were compared with single strains of probiotics in the treatment of IBS, the multi-strain probiotics also did better [34, 35]. 

At The Ruscio Institute, we have had some really good success with gut healing when using a triple therapy approach of Lactobacillus / Bifidobacteria blend, a soil-based probiotic, and Saccharomyces boulardii yeast.

Other Corrective Supplements

Some other supplements that may help correct the underlying causes of constipation are listed in the table below. These won’t be useful for everybody, but you can weigh them up based on your own particular symptoms and health background:

Supplement How it HelpsThings to Note
Herbal antimicrobials, e.g. oil of oregano, berberine, caprylic acidHelps with bad bacteria / infectious microbes, and with stubborn cases of SIBO or other dysbiosis that may underlie constipation Herbal antimicrobials have been shown to be as effective as traditional antibiotics at treating SIBO [36, 37].
Prebiotics, e.g. galacto-oligosaccharides (GOS) and inulin Have been shown to improve stool frequency [38, 39] and transit time [39]. Prebiotics are fibers that good bacteria in the gut love to feed on, and they have been shown to improve dysbiosis in some cases [40]. 3–5 grams is a useful dose of prebiotics for most people. But take care, especially with larger doses as some people are unusually sensitive to prebiotics, which can also cause gas and bloating. 
Digestive enzymesHelp to break down food and have been shown to improve motility in the upper GI tract and improve stool frequency in people with moderate constipation [41]Digestive enzymes can be especially useful if you have specific food intolerances. For example, lactase helps if you have dairy intolerance, and alpha-galactosidase if beans and legumes make you gassy.
Vitamin CHas been shown to be low in constipated children [42]. High-dose vitamin C has been shown to optimize gut bacteria in healthy subjects [43].Unlikely to make a difference if you already had a good vitamin C intake. Can act as an osmotic laxative and cause loose stool at high doses

Constipation Solutions

If you’re constipated and uncomfortable, natural laxatives can be helpful to get your bowel working over the short term. However, it’s important to consider the underlying cause of constipation — for example, lack of fiber, fluid, or nutrients in the diet, or imbalances/overgrowth of bad bacteria. 

By taking action to correct these underlying causes (with probiotics and herbal antimicrobials for example), you’ll usually be able to say goodbye to constipation for good. 

If you need more help with constipation and other gut health-related issues get in touch with us at the Ruscio Institute for Functional Medicine and we will be pleased to help.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References

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