John Tiong Jeh Lung
MPharm, PhD, RPh
Bowel habits vary from one individual to another, although you are generally considered constipated if you have not passed stool in more than 3 days. It is worth knowing that, the longer the stool remains in the large intestine, the more difficult it is for you to defecate as the condition persists. This is due to the water-absorbing function of your large intestine which further dries up and hardens your stool leading to pain during defecation.
Bulking agents, stool softeners or other laxatives (osmotic and stimulant laxatives) are commonly used for treatment of constipation although many patients generally complain of inconsistent responses as well as concerns pertaining to their side effects and safety. Since prolonged administration of these medicines for constipation is not advisable, the use of probiotics as the alternative has been advocated.
What are probiotics?
Probiotics are live microorganisms which can confer health benefits when administered in adequate amounts. They are more commonly referred to as the “good microbes” which can be bacteria or yeast with beneficial effects on the gastrointestinal tract. Lactobacillus (such as Lactobacillus acidophilus) or Bifidobacterium (such as Bifidobacterium bifidus) are two of the most commonly used microbes. Probiotics are present naturally in some food or artificially cultured in others. Examples of food containing probiotics include yogurt, sauerkraut, kimchi, miso soup, soft cheeses, kefir, pickles, cultured milks as well as various supplements (including probiotic drops which are useful for infant and children).
The term prebiotics is sometimes misunderstood as being the same as probiotics, and these terms tend to be mistakenly used interchangeably. Prebiotics are in fact, the indigestible dietary fibres from vegetables and fruits. They serve as food source for the natural gut flora by promoting their normal growth, which in turn can support the optimum function of our gastrointestinal tract. The high content of indigestible fibres in the fecal content can also help to trap more water hence lubricating and loosening stool to ease defecation.
Are probiotics really beneficial for constipation and how do they work?
Scientifically, the term probiotics should be reserved only for live microorganisms that have demonstrated true health benefits in human studies. Outcomes of several meta-analyses examining numerous medical studies have pointed to the benefits of probiotics in increasing the frequency of bowel movements in both adults and children. The administration of probiotics is believed to balance the levels of microorganisms in the intestines which are known to be altered during constipation as well as increasing peristalsis (bowel movement with contraction and relaxation processes) of the large intestine that pushes the intestinal content forward. They are therefore useful for those with constipation. Interestingly, probiotics have also been shown to prevent diarrhea caused by either antibiotics or viral infection. In this context, probiotics help to restore the natural balance of gut flora disrupted by the presence of virus or antibiotics in the intestines.
Are probiotics safe?
Probiotics appear to be associated with fewer side effects than conventional laxatives. Occasionally, some individuals may experience stomach bloating, belching and flatulence for a short period of time until the gastrointestinal tract adapts to the increased in the number of microbes. If you are taking some medications at present or if you have existing medical condition that is associated with weakened immune system, it is advisable to speak to your health care providers before you start taking probiotics.
Huang, R., & Hu, J. (2017) Positive Effect of Probiotics on Constipation in Children: A Systematic Review and Meta-Analysis of Six Randomized Controlled Trials. Front. Cell. Infect. Microbiol.
Dimidi et. al. (2014) The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. The American Journal of Clinical Nutrition 100(4):1074-1085.