Constipation is medically defined by the passing of infrequent bowel motions (stools), fewer than 3 per week. It can be accompanied by the passage of hard, dry, or lumpy stools that are difficult to pass. Constipation may be associated with a sensation of incomplete bowel emptying [1, 2, 3] 
 
Chronic constipation leads to a considerable loss of quality of life and can increase healthcare costs. It is a common reason for primary care visits and referrals to gastroenterologists [1,2]. 

Other effects of constipation on the body may include loss of appetite, bloating, fatigue, skin problems and mental health. The sensation of fullness and difficulty to pass stools can lead to physical discomfort and negatively impact your daily activities and overall well-being [4].  

While many cases of constipation are not life-threatening, it is important to seek healthcare advice if it becomes on-going, and if any of the following symptoms are present: rectal loss of blood, rectal pain, fever, weight loss, nausea, vomiting and family history of inflammatory bowel disease and colorectal cancer [2].  

Constipation: Statistics & Facts 
Approximately 1 in 4 Australian adults suffer from constipation [5].   

Constipation is significantly more prevalent in adult females compared to males [6].  

Constipation is not commonly talked about, with only 1 in 10 individuals with constipation seek care from a healthcare professional [6].  

Life-Style Related Causes Of Constipation: 

  • A change in routine such as travel or shift work 
  • Low-fiber diet (which reduces Short Chain Fatty Acids (SCFAs) and transit time) 
  • Insufficient water intake 
  • Lack of regular exercise 
  • Some medications 
  • Pregnancy 
  • Age 
  • Illness 
  • Psychological stress [1,7] 

 

Probiotics vs Laxatives: How Do They Differ In Relieving Constipation? 

What is a Probiotic? 

Probiotics metabolise prebiotics to produce beneficial nutrients and metabolites.  
They interact with the human host to perform a variety of beneficial health functions [8].  
The community of microorganisms in the gut known as the microbiome work in partnership with the human body to perform key functions [9]. 

What is a laxative? 
Laxatives are a category of medications frequently used to address constipation. Many are available over-the-counter at pharmacies. Their primary mechanism involves enhancing digestion and promoting bowel movements, thereby facilitating the process of bodily excretion [10]. 

There are different types of laxatives available, with the most common ones being: 
Bulk forming laxative: These agents retain fluid in the stool, increasing stool weight and consistency. Psyllium, dietary fiber, and methylcellulose are common examples 
Osmotic agents: This class of medicines is poorly absorbable and draws water into the lumen of the bowel. 
Stimulants: Increasing intestinal secretions and motility. They also decrease the absorption of water from the lumen of the bowel [10].  

While laxatives can be effective for relief from constipation, it is important to note that extended use or reliance on them can lead to habituation. Habituation implies a reduction or disappearance of laxative response, while tolerance refers to the need to increase laxative dose to achieve the required result [11]. 

Side-effects: Laxatives may also contribute to side effects such as abdominal pain, diarrhea, bloating, urgency, nausea and vomiting [10].  

Probiotics: How They Work 

Probiotics work in a more gentle and sustained approach which seek to restore balance to the gut and body. They require daily consumption, along with other lifestyle changes. Rather than encouraging the body to excrete after a build-up, probiotics help improve the environment and functioning of the microbiome, which promotes regular bowel motions [12, 13]. 

Rather than stimulating or drawing water into the bowel, they can: 

  • Improve gut microbiome balance 
  • Increase gut transit time 
  • Soften stools 
  • Reduce bloating, pain and inflammation 
  • Increase intestinal motility via SCFAs 
  • Regulate the enteric nervous system [12, 13, 15] 

 

Probiotic Strains 
There are hundreds of different probiotic strains which, all of which have different targeted actions. We most commonly hear about groups of bacteria such as lactobacillus and bifidobacterium which are present in foods such as yoghurt. However, there are many strains which have been clinically researched for targeted use and which have been selected, in clinically relevant dosages, to have a specific therapeutic outcome [13, 14, 15].  

Bifidobacterium lactis DSM 15954 (equivalent to BB-12) 
This probiotic strain has been widely researched and indicated specifically for constipation relief. It has demonstrated effects on gastrointestinal function and bowel regularity and shown to significantly increase defecation frequency in adults with constipation. Bifidobacterium lactis DSM 15954 increases the production of SCFAs in the gut, increasing motility and peristalsis [16, 17, 18]. 

We have included this strain in our Constipation Relief product at a clinically studied dose of 10 Billion CFU per capsule (one dosage) [16].  

Therapeutic Dosage 
When looking for a targeted constipation product, it is important to select a product with clinically evidenced dosages of the strains which offer a therapeutic benefit. This can be confusing to navigate, especially in multi-strain products. 

A higher CFU (Colony Forming Unit), which is the number of viable bacteria in a probiotic, doesn’t always indicate that it is better. There are different clinical dosages depending on different strains and even strain combinations [14, 19].  

It is advisable to check with your healthcare practitioner for recommendations on the best product based on strain selection and dosage of the strain as indicated for your needs. 

A Hybrid Approach To Managing Constipation: 

Managing constipation is not a one-size-fits-all approach, and is generally not as simple as taking a laxative or probiotic. It involves a consistent, individualized and holistic approach to healthy living which may include the following: 

  • Improve and Balance Microbiome: this may involve selecting specific probiotic supplements to address deficiencies or overgrowth of certain strains. Some individuals opt-in for a stool test to analyze their gut microbiome in-depth. Please consult your healthcare professional about this and the interpretation of the results.  
  • Increase Intake of Dietary Fibre: Good sources of fibre include fruits and vegetables, wholegrains, legumes, nuts and seeds. 
  • Fluid Intake: Drinking adequate amounts of water which helps to make stools softer and easier to pass. Males need about 10 cups (2.6 litres or 2600mL) of fluids everyday, females need about 8 cups (2.1 litres or 2100mL) of fluids a day.  
  • Physical Activity: Increase regular physical exercise to aid healthy bowel movements  
  • Functional foods: The term functional food refers to food with specific beneficial functions, is first coined in Japan. This includes food which naturally contain pre, pro and postbiotics. These include yoghurt, cheese, kefir, sauerkraut, miso and other fermented foods which are naturally high in pre, pro and postbiotics.  
  • Managing Stress: the gut microbiome is affected by the stress hormone, cortisol. Managing stress levels, ensuring that there are ample windows for your parasympathetic nervous system (“rest and digest”) can help encourage bowel motions and reduction of gut symptoms. 
  • Integrative Approaches: these include yoga, acupuncture and TCM, nutraceuticals, herbal medicines, colon hydrotherapy and reflexology [1, 3, 7, 20, 21, 22]. 

 

What To Look Out For In A Supplement: 

When managing constipation, the aim is to support long-term gut health and balance, as opposed to a quick-fix.  

Some of the claims you may want to look out for on products are: 

  • Maintain/support general health and wellbeing  
  • Decrease/reduce/relieve constipation  
  • Helps reduce occurrence of constipation  
  • Enhance/improve/promote/increase bowel regularity  
  • Softens stool to ease bowel motions  
  • Maintain/support healthy bowel/colon function  
  • Maintain/support healthy digestive system function  
  • Maintain/support digestion/assimilation of nutrients  
  • Maintain/support digestive system health  
  • Maintain/support intestinal good/beneficial/friendly flora  
  • Helps restore good/beneficial/friendly intestinal/gut/bowel flora  
  • Maintain/support small intestine good/beneficial/friendly flora  

 

It is important to select products which include evidence-based strains, which means they have been clinically studied, researched and trialed. It is also key to look out for the dosage used in the supplements, ensuring that the dosage is appropriate for your specific needs and the relevant research.  

*Disclaimer for Pregnancy & Breastfeeding: if you are pregnant or breastfeeding, please consult your healthcare provider for tailored advice.  

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