Approximately five to 30% of individuals in Western countries suffer from constipation. (8)(19) Symptoms of constipation and constipation-predominant irritable bowel syndrome (IBS-C) can significantly impact an individual’s quality of life. (14) Treatment for constipation and IBS-C may include dietary and lifestyle modifications, as well as certain dietary supplements, such as inulin, probiotics, and psyllium husk.
What is constipation?
Constipation is an intestinal dysfunction characterized by hard stools, abdominal pain, abdominal swelling or distension, and a feeling of incomplete elimination. (19)
Constipation may also be a symptom of irritable bowel syndrome (IBS), a group of functional disorders that affect the digestive system. The pathophysiology of IBS is complex but may involve an imbalance of gut microbiota (5) and dysfunction in gut-brain communication. (9) Several mechanisms of the condition have been identified, including altered motility and transit, psychosocial factors, and heightened sensitivity of the intestine or colon. (14) The different types of IBS include:
- IBS-D: diarrhea-predominant
- IBS-C: constipation-predominant
- IBS-M or IBS-A: a combination of both diarrhea and constipation (9)
Constipation causes and risk factors
Several causes and risk factors have been associated with constipation and IBS-C, including:
- Age: increased risk in the elderly
- Certain health conditions (e.g., celiac disease, diabetes, hypothyroidism, Parkinson’s disease)
- Certain medications (e.g., antacids, anticonvulsants, calcium channel blockers, diuretics)
- Ethnicity: increased risk in non-Caucasians
- Gender: increased risk in females
- Insufficient hydration
- Iron-containing dietary supplements
- Low dietary fiber intake
- Physical inactivity (4)(11)(15)(10)
Constipation signs, symptoms, and complications
Symptoms of IBS may appear, disappear, and change over time. (14) The signs and symptoms of IBS-C and general constipation include:
- Hard or compact stools
- Increased effort to eliminate
- Stool frequency less than three times per week
- The sensation that elimination is incomplete
- The sensation that elimination is obstructed (19)
Constipation may result in fecal impaction (4) and increase the risk of colorectal cancer. (19) Comorbidities of IBS include chronic fatigue syndrome, fibromyalgia, gastroesophageal reflux disease, anxiety, and depression. (9)
Supplement ingredients for constipation relief
The supplements outlined below have demonstrated effectiveness in addressing constipation.
Inulin is a prebiotic fiber present in the roots and rhizomes of various plants, such as chicory, garlic, and artichoke. (19) Inulin resists digestion by human digestive enzymes, meaning it passes through the small intestine to reach the colon, where it is fermented by bacteria. (8) Prebiotics, including inulin, have been shown to alter the composition of intestinal microbiota by increasing beneficial Bifidobacterium and Lactobacillus. (15)(19) Several mechanisms have been proposed to explain the beneficial effects of prebiotics in cases of constipation, including modulation of gut microbiota, reduction of intestinal pH, and increases in bowel movements, stool weight, and water content in the colon. Further, supplementation of inulin may also decrease pathological Clostridium bacteria. (15)
Inulin has demonstrated effectiveness in improving transit time, stool frequency, stool consistency, and hardness of stool. (15)
Probiotics are live microorganisms found in fermented foods and dietary supplements that confer beneficial effects to the host once consumed. Research has demonstrated that certain strains of bacteria may improve symptoms of IBS, antibiotic-associated diarrhea, gastroenteritis, and Clostridium difficile infections. (5) Probiotics may address constipation through their ability to improve intestinal motility, modify gastrointestinal microflora, and alter biochemical factors in the gut. (6) When applied clinically, it’s important to consider the specific strains of probiotics used as studies have shown that the benefits of a specific strain may not apply to other bacterial strains, even from the same species. (5)
Bacillus subtilis and Streptococcus faecium have been shown to improve abdominal pain, stool consistency, and stool frequency. (3) One study found that Lactobacillus reuteri significantly improved pain, bloating, gas, and abdominal discomfort. (13) Further research has shown that Bifidobacterium longum may improve constipation symptoms in elderly patients. (7)(13)
Psyllium husk, a commonly used soluble fiber supplement, is produced from the seeds of certain plants in the Plantago genus. The seeds are milled to remove the hulls and the remaining husk and seeds are used to formulate dietary supplements. There is a significant interest in psyllium due to its potential for the prevention and treatment of IBS, irritable bowel disease (IBD), and diverticulosis, among other conditions. Psyllium husk is water-soluble and promotes large bowel function by forming bulk in the stool. (16) The primary active constituent in the seed is the mucilaginous hydrocolloid, which is made up of mostly arabinoxylans. Psyllium husk should be mixed with water, and increased water intake is commonly recommended when increasing the consumption of soluble fiber in the diet. (17)
Extensive research has demonstrated the effectiveness of psyllium husk in improving the signs and symptoms of chronic constipation. Benefits include increased stool frequency, improved stool consistency, and reduced pain when defecating. (1)(2)(12)(18)
The bottom line
Constipation is a common condition that can impact digestive health and overall quality of life. Research shows that dietary supplements including inulin, probiotics, and psyllium husk may benefit individuals with constipation. A protocol using natural supplements can be used therapeutically on its own or as an adjunct to existing treatment. If you’re a patient, we recommend speaking with your healthcare provider to learn whether these supplements are ideal for your wellness plan. If you’re a practitioner, view our hard stools protocol.
- Ashraf, W., Park, F., Lof, J., & Quigley, E. M. M. (2007). Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. Alimentary Pharmacology & Therapeutics, 9(6), 639–647.
- Cheskin, L. J., Kamal, N., Crowell, M. D., Schuster, M. M., & Whitehead, W. E. (1995). Mechanisms of constipation in older persons and effects of fiber compared with placebo. Journal of the American Geriatrics Society, 43(6), 666–669.
- Choi, C. H., Kwon, J. G., Kim, S. K., Myung, S.-J., Park, K. S., Sohn, C.-I., … Park, H. (2015). Efficacy of combination therapy with probiotics and mosapride in patients with IBS without diarrhea: A randomized, double-blind, placebo-controlled, multicenter, phase II trial. Neurogastroenterology & Motility, 27(5), 705–716.
- Closa-Monasterolo, R., Ferré, N., Castillejo-Devillasante, G., Luque, V., Gispert-Llaurado, M., Zaragoza-Jordana, M., … Escribano, J. (2016). The use of inulin-type fructans improves stool consistency in constipated children. A randomised clinical trial: Pilot study. International Journal of Food Sciences and Nutrition, 68(5), 587–594.
- Drouault-Holowacz, S., Bieuvelet, S., Burckel, A., Cazaubiel, M., Dray, X., & Marteau, P. (2008). A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroentérologie Clinique Et Biologique, 32(2), 147–152.
- Ibarra, A., Latreille-Barbier, M., Donazzolo, Y., Pelletier, X., & Ouwehand, A. C. (2018). Effects of 28-day Bifidobacterium animalis subsp. lactis HN019 supplementation on colonic transit time and gastrointestinal symptoms in adults with functional constipation: A double-blind, randomized, placebo-controlled, and dose-ranging trial. Gut microbes, 9(3), 236–251.
- Martínez-Martínez, M. I., Calabuig-Tolsá, R., & Cauli, O. (2017). The effect of probiotics as a treatment for constipation in elderly people: A systematic review. Archives of Gerontology and Geriatrics, 71, 142–149.
- Micka, A., Siepelmeyer, A., Holz, A., Theis, S., & Schön, C. (2016). Effect of consumption of chicory inulin on bowel function in healthy subjects with constipation: A randomized, double-blind, placebo-controlled trial. International Journal of Food Sciences and Nutrition, 68(1), 82–89.
- National Institutes of Health. (2017, November 1). Definition & facts for irritable bowel syndrome. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts
- National Institutes of Health. (2018, May 1). Definition & facts for constipation. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/definition-facts
- National Institutes of Health. (2018, May 1). Symptoms & causes of constipation. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/symptoms-causes#medicines
- Noureddin, S., Mohsen, J., & Payman, A. (2018). Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: A randomized trial in patients with type 2 diabetes and chronic constipation. Complementary Therapies in Medicine, 40, 1–7.
- Riezzo, G., Orlando, A., D’Attoma, B., Linsalata, M., Martulli, M., & Russo, F. (2018). Randomised double blind placebo controlled trial on Lactobacillus reuteri DSM 17938: Improvement in symptoms and bowel habit in functional constipation. Beneficial Microbes, 9(1), 51–60.
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- Wärnberg, J., Marcos, A., Bueno, G., & Moreno, L. A. (2009). Functional benefits of psyllium fiber supplementation. Current Topics in Nutraceutical Research, 7(2).
- World Health Organization. (1999). WHO Monographs on selected medicinal plants – Volume 1: Semen plantaginis. Retrieved from: https://apps.who.int/medicinedocs/fr/d/Js2200e/22.html
- Yang, J., Wang, H. P., Zhou, L., & Xu, C. F. (2012). Effect of dietary fiber on constipation: A meta analysis. World Journal of Gastroenterology, 18(48), 7378.
- Yurrita, L. C., Martín, I. S. M., Ciudad-Cabañas, M. J., Calle-Purón, M. E., & Cabria, M. H. (2014). Effectiveness of inulin intake on indicators of chronic constipation; a meta-analysis of controlled randomized clinical trials. Nutricion Hospitalaria, 30(2), 244-52.