Nobody likes being backed up – in traffic, in a stalled commuter train, and of course, in our bowels. The subject that used to be shameful or embarrassing to discuss is now out in the open – constipation. It happens.
According to the National Institutes of Health (NIH), constipation is defined when you have: fewer than three bowel movements per week, stools that are dry, hard, lumpy and difficult to excrete, and a feeling that you still didn’t excrete it all.
These are basic factors that characterize constipation. Keep in mind, too, that normal patterns are different between individuals; some people go several times in a morning, others once. Some people go after meals, others only once every other day. And, says the NIDDK, approximately 16 out of 100 American adults have constipation, and this number rises to 33 out of those 60 and older.
Other people who are more likely to become constipated are those who eat very little fiber regularly, those with IBS, and pregnant women and new mothers. And certain medications may cause or exacerbate constipation, such as antacids that contain calcium, narcotic pain medication, diuretics, and some depression medications. Iron supplements can also cause a backup.
Other Causes of Constipation
Relying too much on laxatives: Peristalsis is the natural, wave-like rhythmic movement of the large intestine that pushes stool along and out. Stimulant laxatives encourage the large intestine to speed up its rhythm. IN some cases, peristalsis is slowed and a stimulant laxative every now and then is ok. When one relies on taking these laxatives, the large intestine is conditioned to let the laxative do the job rather than itself. Laxative reliance can eventually cause constipation when you stop taking them. The other type of laxative is osmotic, which is a stool softener; this type works by increasing water secreted into the large intestine.
No or insufficient exercise: Exercise not only makes you look good and toned, it tones everything, including your GI tract. Good muscle tone helps the body keep bowel movements regular. Core exercises help strengthen the abdominal muscles and the diaphragm which work in concert to help excretion. Lack of exercise means lax muscles.
Insufficient dietary fiber and water: Fiber and water (or other non-viscous fluids) work together to cause stools to be softer and larger and thus easier to move along the lower GI tract and out. Your diet should have soluble fiber (which dissolves in water) and insoluble fiber, which encourages movement of stool through your intestines.
Stress: Psychological stress can wreak havoc on one’s GI system. While some people become nauseated, others are prone to diarrhea, others become constipated. These symptomatic reactions to stressful events are stimulated by the hypothalamus-pituitary-adrenal axis and release of a biochemical (stress-induced corticotrophin-releasing factor or CRF) that act on the bowel through the central nervous system. And, one study links CRF with the composition of gut microbiota, leading the authors to write that this evidence lends support for consumption of probiotics.
Constipation is not a disease, it is mostly an annoying condition that impacts quality of life. You feel bloated, you may have some brain fog, you feel sluggish. And if you are relatively healthy but feel too often backed up, you can take probiotics to help keep your lower GI functioning well.
How Probiotics Help Alleviate Constipation
Probiotics are essential to your microbiome; they increase the bacterial colonies (collectively called microbiota) that serve to protect against incoming pathogens, and also ensure healthy functioning of the host (you). The intestinal microbiota performs numerous health-promoting tasks. The friendly flora assist in the breakdown of food into absorbable nutrients, stimulate healthy immune response, prevent growth of pathogenic bacteria and produces a great variety of biologically important compounds.
A study that colonized intestinal microbiota in germ-free rodents showed that both Lactobacillus acidophilus and Bifodobacterium bifidum reduced the period of migrating motor complex activity (waves of electrical activity that sweep through the intestines between meals to “clean house” ) and also accelerated transit in the small intestine – meaning, the probiotics helped improve motility for bowel movement.
The authors of a published review discussing the roles of intestinal microbiota in chronic constipation found the following: Bifidobacterium lactis DN-173 010 increased stool frequency, condition and consistency; Lactobacillus reuteri DSM 17938 increased bowel frequency; and B. lactis GCL, B. lactis Bi-07 and L. paracasei IMPC 2.1 all had “beneficial effects” in those with constipation.
And there are differences found in the gut microbiota in people with chronic constipation compared to those who are regular in their bowel movements. Further, there is mounting evidence that alterations in the gut flora may exacerbate constipation and constipation-related symptoms.
A human study that investigated the status of the microbiota in women with chronic constipation by comparing fecal and colonic lining microbiota. They found that the microbiota composition in the colonic lining differed between constipated individuals and those who did not have constipation.
The impact of several probiotics on healthy bowel transit and constipation was the subject of a meta-analysis which found that probiotics, specifically Bifidobacterium lactis, significantly reduced whole gut transit time by 12.4 hours and increased bowel movements by 1.3 times per week.
Yet another review looked how several probiotics affect healthy transit and bowel evacuation. Several studies found that adults with constipation exhibited significantly lower numbers of bifidobacteria and lactobacilli in stools compared to adults with normally functioning bowels. Further, studies revealed that consumption of several probiotic strains positively affected motility and transit time, providing benefit to those who have constipation.
The review cited several studies showing positive effect of several probiotic supplements (specifically B. animalis DN-173010, L. casei Shirota, B. lactis Bf-6 and B. lactis HN-019) on gut transit time, which results in lessened constipation. Additionally, gut microbiota and the SCFAs produced by the flora have been shown to be imbalanced in people with constipation.
Prebiotics (substances that help probiotics flourish) should be considered for promoting healthy bowel function as well. Prebiotics serve to help probiotics thrive in the gut. A key prebiotic, fructooligosaccharides, is a soluble fiber that also is effective to help promote regular bowel movements for people with chronic constipation. One study found that older people who consumed FOS (20 g a day for 30 days) significantly increased bowel regularity and stool quality and bulk. Another prebiotic, isomalto-oligosaccharides, was found to improve the colonic microbiota constitution and bowel function in older people.
Probiotics should be taken routinely – as they help replenish your microbiota, and through time you will notice positive differences in your gut and bowel elimination (better stool quality and quantity and more regularity).
In the meantime, more immediate and gentler relief to help you move may be obtained through three herbs, as follows:
Senna: This herb acts somewhat swiftly, about six to 12 hours after taking it in tablet, capsule or liquid extract form. It’s also available in herbal teas. However, you should not take it daily for more than one week. It contains anthraquinones, which are potent laxatives. It also inhibits the colon from reabsorbing water and electrolytes, which softens stool.
Cascara sagrada: Similar to senna, cascara (also called buckthorn) likewise contains anthraquinones, which trigger peristalsis, resulting in emptying of the bowels. It can cause cramping and electrolyte imbalance, however. It too is not recommended for regular use.
Psyllium: A gentler fiber, psyllium husk has been used traditionally to move things along. It is a bulk-forming laxative (increases stool size through absorbing water) and thus facilitates healthy bowel movements.
Constipation happens to everyone at some point and some individuals are more prone to being backed up than others. You know your body best, so when you find that the going is getting a bit tough, look at your lifestyle – diet, exercise and stress management. Then add probiotics and prebiotics to your daily supplement/functional food and beverage regimen.