Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.
Americans spent $1.43 million on over-the-counter laxatives in 2019 . When you consider that chronic constipation negatively impacts social functioning and quality of life , it’s clear that a lot of people suffer in silence with this condition.
Chronic constipation is a common digestive disorder, affecting up to 27% of the population . And while constipation can affect anyone, it is more common among women and adults over 65 years of age .
Constipation is officially defined as having fewer than 3 bowel movements per week and/or having hard stool that is difficult to pass. However, in functional medicine, having 1-3 healthy bowel movements per day is one of the benchmarks of good digestive health.
Laxatives are fine for occasional constipation. However, for chronic conditions, it’s best to address the root causes. Probiotics help to correct the bacterial imbalances that underlie many cases of constipation.
Constipation and Gut Dysbiosis
For some people, overcoming constipation is simply a matter of making better food choices. If your diet is high in processed foods, adding fiber-rich whole foods and drinking enough water may be all that’s needed.
But fiber can be a double-edged sword if your constipation is caused by gut dysbiosis, an imbalance of the microorganisms in the digestive tract. Fiber feeds your gut bugs. Eating more fiber may make constipation, bloating, and abdominal pain worse [4, 5], particularly if you have an overgrowth of harmful bacteria.
Chronic constipation and gut dysbiosis can be a self-perpetuating cycle. As fecal matter sits immobile in your digestive system, it encourages more growth of harmful bacteria and yeast, creating more constipation. Digestive system overgrowths can also cause inflammation and leaky gut, which can lead to other symptoms like fatigue, brain fog, food sensitivities, itchy skin, and more.
Probiotics can be very helpful in breaking the cycle of chronic constipation.
How Can Probiotics for Constipation Help?
Probiotics, or “good bacteria,” are bacteria species that we consume for their health benefits. Probiotics are capable of improving the health of your gut microbiome and can fight harmful microorganisms [6, 7, 8, 9].
Research shows that the beneficial bacteria in probiotic supplements can help with chronic constipation. Several systematic reviews and meta-analyses (the highest quality of research) have shown that probiotics:
Significantly improve stool frequency [10, 11, 12]
Improve the quality of life of constipated patients 
While research clearly shows that probiotics can significantly improve constipation in adults and elderly people , the effect of probiotics are less conclusive for children [16, 17, 18]. Since the prevalence of bacterial overgrowths like SIBO increases with age , this may be a factor in the differences between adults and children when it comes to the success of using probiotics for constipation.
As a result of balancing gut microorganisms, probiotics also reduce inflammation , promote a healthy immune system function [20, 21, 22], and reduce damage to your gut lining (leaky gut) [23, 24, 25].
Best Probiotics for Constipation
One meta-analysis of 15 clinical trials showed that multi-strain probiotics were more effective than single-strain probiotics for increasing stool frequency, improving stool consistency, and reducing bloating . Similar results have been found when comparing multi-strain and single-strain probiotics for treating irritable bowel syndrome (IBS) [26, 27].
I’ve seen similar results using probiotics for constipation in my clinic. Many people don’t seem to achieve balance in their gut microbiome with just one strain of probiotic. For many patients who have tried probiotic supplements without much success in the past, a multi-strain approach makes all the difference. For this reason, I recommend a comprehensive approach that includes all three categories of probiotics.
Probiotic Triple Therapy
You don’t need to try every different probiotic strain on the market, hoping to find the right one. Probiotic Triple Therapy is a comprehensive approach and eliminates the guesswork of choosing probiotic products.
Nearly every probiotic product can be classified into one of three categories . When following the Probiotic Triple Therapy protocol, you’ll pick one quality supplement from each category.
Lactobacillus & bifidobacterium species predominated blends
Saccharomyces Boulardii (a healthy fungus)
Soil-Based Probiotics using various Bacillus species
These are the most well-researched, with well over 500 trials assessing their validity. These live microorganisms are also known as lactic-acid producing probiotic bacteria. They include a large number of well-known probiotic species, such as: ⚫️ Lactobacillus acidophilus, ⚫️ Lactobacillus Plantarum, ⚫️ Lactobacillus casei, ⚫️ Lactobacillus reuteri, ⚫️ Bifidobacterium lactis, ⚫️ Bifidobacterium longum, ⚫️ Bifidobacterium infantis
The second most researched probiotic, with more than 100 studies. Saccharomyces boulardii (S. Boulardi for short) is not a normal part of human gut microbiota, meaning it does not colonize us but does improve the health of the host.
The third most researched category of probiotics is soil-based probiotics. This category is also known as spore-forming bacteria. This category of probiotic can colonize the host. 
Monitor your symptoms for 3-4 weeks. If you’re improving, stay on the Probiotic Triple Therapy protocol until your improvements have plateaued.
Once you’ve seen your maximum improvement (you’ve plateaued), stay on the protocol for about a month to allow your system to calibrate to these new improvements. Then, reduce your dose and find the minimal effective dose. Stay on the minimal effective dose.
If you haven’t noticed any change in your symptoms after 3-4 weeks, you can stop taking probiotics and feel confident that you have fully explored probiotic therapy. There’s no need to shop for other strains of probiotics.
Rachel came to see me after reading my book, Healthy Gut, Healthy You. She had IBS-C and only went to the bathroom once every 5-6 days. Her struggle with constipation was lifelong, and she had tried many different natural treatments with little success.
With my support, Rachel started using Probiotic Triple Therapy. Within 48 hours, her lifelong constipation normalized. She also noticed that her mood was better. Rachel continued to take probiotics and was able to reduce her dose over time.
Not everyone enjoys the benefits of probiotics as quickly as Rachel. Allow at least three weeks to see if Probiotic Triple Therapy works for you. Even small improvements in your symptoms should be taken as a good sign that probiotics are working to restore your gut health.
Additional Treatments for Constipation
For some patients, probiotics offer a partial solution, improving but not eliminating symptoms. If this is your experience, you may benefit from these additional treatment options:
Prokinetic agents are drugs or natural supplements that help increase the strength and coordination of your migrating motor complex (MMC). The MMC is a complex system of nerves, muscles, and neurotransmitters that moves waste through the gastrointestinal tract. Prokinetic agents aren’t harsh like most laxatives and are better suited for long-term use.
It’s very important to keep waste moving through your gut. When fecal matter becomes trapped in your digestive tract, harmful bacteria thrive. Poor gut motility contributes to SIBO and other conditions of bacterial overgrowth.
A recent meta-analysis compared 36 clinical interventions for chronic constipation . Probiotics combined with a prokinetic agent was found to be the most effective treatment.
MotilPro is an effective natural prokinetic agent. There are also a number of prescription options for prokinetic agents. A recent meta-analysis reviewed 33 clinical trials involving 17,214 patients to determine which drug was most effective for constipation . While prucalopride was not the most effective initially, it ranked as the most effective after 12 weeks of therapy.
Low Fiber Diet
Fiber consumption works well for some, however it can be very counterproductive for others with functional constipation . That’s because fiber may feed the gut bugs that cause constipation.
If you’ve tried high-fiber diets without success, it may be time for a different approach. One clinical trial found that a low- or no-fiber diet significantly improved constipation and bloating . In the study, 41 patients who completely stopped fiber intake increased bowel movement frequency from once every 3.75 days to once per day.
The low FODMAPs diet was designed to remove all fermentable fibers that feed gut bugs. It can be helpful for treating gut dysbiosis, IBS, and leaky gut [38, 39, 40, 41, 42, 43].
Antibiotic therapy may be needed to reduce harmful gut bacteria if other treatments aren’t successful. Research shows that antibiotic treatment with Rifaxamin eliminates SIBO for 67% of patients .
Herbal antimicrobials are more commonly used in functional medicine and work the same way as antibiotics. There’s not as much research for herbal antimicrobials, but they have been shown effective for IBS and SIBO [45, 46].
Herbal antimicrobials have beneficial side effects and fewer risk factors when compared to antibiotic treatment. They are anti-inflammatory and possibly antidepressant [47, 48]. They can be effective for eliminating bacteria, fungi, and protozoa while antibiotics mostly work against bacteria .
Some SIBO patients relapse after antimicrobial and antibiotic therapy. For many patients, ongoing management of digestive function with probiotics, prokinetic agents, and/or a low fiber diet can help to prevent relapse.
Set Yourself Free from Constipation
Constipation is uncomfortable, frustrating, and can be a lifelong struggle without the right advice. Many patients haven’t found much support in the conventional medical system, beyond the faulty advice to consume more fiber.
Your health depends on good elimination. Treatment of long-term, chronic constipation is possible. Start with the beneficial effects of probiotics and consider additional treatment recommendations if needed.
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