Constipation is a frustrating and common problem that affects up to 15% of us at any one time. Probiotics can play a key role in helping to relieve constipation, but it can be confusing trying to choose the correct and most effective one. Here we aim to demystify the confusion surrounding probiotics and help you get the most out of your friendly bacteria.
How do probiotics relieve constipation?
Our intestines are comprised of billions and billions of bacteria, and when an imbalance occurs (known as dysbiosis) it can often lead to digestive symptoms, such as constipation. The majority of bacteria that makes up our large intestine are the Bifidobacteria and Lactobacillus species, therefore it makes sense that probiotics with specific strains belonging to these species are generally regarded as most beneficial in helping to reduce constipation. Some probiotics produce lactic acid and short-chain fatty acids (SCFAs) that lower the pH in the colon which heightens muscle contractions along the colon (peristalis) to enhance regularity.
Our intestinal microflora is made up of many different species and strain of bacteria
Some Bifidobacterium and Lactobacillus species can enhance bowel regularity and mucous secretion by converting bound bile salts into free bile salts. These free bile salts cause more water to be pulled into the colon which softens the stool and aids elimination.
Although there are many possible triggers for constipation, and as a result no 'one size fits all' solution, fortunately there is good evidence to show that probiotics can be effective. Not all are the same however, and their effect may depend on the strain being used. Due to the different benefits held by the variety of strains, it is often found that a combination in one supplement is particularly effective.
You can read more about the role probiotics may play in helping to relieve constipation here.
All probiotics are not equal
It is worth being aware that each probiotic strain is different from the next, and only some belonging to a species of bacteria carry specific health benefits. It is always recommended you select a strain that has been clinically trialled with a proven health benefit. It is also key that your chosen strain has been tested to survive stomach acidity and bile salts otherwise it may effectively be useless.
We will look more closely at different strains of probiotic bacteria and their benefits for constipation
Also try to bear in mind that we are all individuals and what works for one person may not do so for the next. We therefore encourage you to do your research and experiment in order to help determine what is most suitable for you.
Here we aim to identify the best probiotic strains for helping to relieve constipation, and have selected those that have been clinically trialled for their health benefits. We hope our list helps you choose the most suitable probiotic to help with your symptoms.
1) Bifidobacterium lactis
Bifidobacterium lactis BB-12 is a very well researched probiotic strain which has repeatedly demonstrated effectiveness at reducing constipation. This particular probiotic strain of B.lactis BB-12, has been investigated in several trials for constipation; including one with IBS patients and one with constipated elderly patients1,3,4. The results were very positive and patients saw significant improvements in their symptoms and a reduction in their constipation. BB-12 can be found in OptiBac Probiotics Bifidobacteria & fibre.
Another B.lactis strain shown to be effective at helping relieve constipation in a number of studies is B. lactis DN-173 010. The largest double-blind study (which is considered to be the gold standard of trials) was performed in 267 patients with IBS-C (the type of IBS associated primarily with constipation symptoms). After six weeks, a significantly increased stool frequency was observed in patients. However, it is interesting to note that while the results for adult constipation were positive; in a double-blind trial with constipated children, B. lactis DN-173 010 wasn’t effective, therefore this strain has been shown to be less helpful for children (see below for further information regarding constipation in children)15. This is a clear example of how not every strain of probiotic is effective for everyone, and it really is worth finding the one relevant to you.
Bifidobacteria makes up the majority of bacteria specices in the large intestine
2) Lactobacillus casei rhamnosus
Lactobacillus casei rhamnosus GG (or LGG as it is more commonly known) is a well researched strain of probiotic bacteria with known health benefits, some of which include reducing constipation, but the results are mixed. A pilot study which tested a combination of probiotics (Bifidobacterium bifidum, B. infantis, B. longum, Lactobacilli (L.) casei, L. plantarum and L. rhamnosus) was shown to be effective in increasing bowel movements. However, a later study showed no benefit in administering LGG to constipated children who had been administered lactulose (a commonly prescribed constipation remedy)12. This may suggest that LGG may not provide significant benefits in the treatment of constipation and more studies are required, preferably testing LGG alone to assess the benefits.
A study carried out on a different strain, Lactobacillus casei rhamnosus Lcr35, demonstrated a benefit in reducing chronic constipation in children when compared to magnesium oxide and a placebo.10
Lactobacillus is another dominant bacteria species found in the large intestine
3) Bifidobacterium animalis
In a double-blind parallel study in 70 healthy adults, drinking a daily combination of 375g of milk fermented with the specific B.animalis strain DN-173 010 for 11 days reduced colon transit time by 20%. Interestingly the effect was more pronounced in women8. As a result another study was carried out to confirm the benefit of B.animalis DN 173 010 for reducing transit time in those suffering from constipation7.
4) Bifidobacterium longum
A randomised controlled trial involving a total of 636 patients (250 men, 386 women) suffering from constipation dominant IBS taking a prepared combination of Bifidobacterium longum W11 with the prebiotics FOS (fructooligosaccharides) in treating constipation in men was shown to have a positive outcome in terms of improving stool frequency and consistency11.
Although there are few other trials supporting this outcome, the results of this particular study certainly looks encouraging and we would always welcome further research in this area.
Evidence suggests that B.longum W11 strain of probiotic bacteria may help relieve constipation
5) Lactobacillus plantarum
L.plantarum has become popular as an effective remedy for relieving IBS symptoms, however as mentioned previously, it is important to note that only certain strains of L.plantarum have been clinically trialled for their role in helping with IBS (see 'All probiotics are not created equal'). The probiotic strain L.plantarum 299v has been shown in trials to be helpful in reducing abdominal bloating and discomfort associated with IBS, but not specifically for constipation13. More evidence that there really is no one size fits all when it comes to probiotics and reducing symptoms!
The strains L.plantarum SN13T and L.plantarum SN35N were shown in a double blind randomised trial involving 68 healthy adults who experienced symptoms of constipation to be effective at reducing their symptoms (as well as improving their liver function)14.
Probiotics for constipation in children
As many parents are unfortunately aware, constipation is a common and unpleasant condition affecting babies and children. There are certain strains of probiotic bacteria that have been shown in studies to be effective for children. They have also demonstrated benefits for helping relieve constipation in adults too, but if childhood constipation is relevant to your family, you may like to try these:
6) Bifidobacterium infantis
Bifidobacterium infantis is one of the main species of bacteria that makes up a healthy bowel flora in infants, in addition to Bifidobacterium bifidum. These are the dominant and most important beneficial cultures found in healthy infants and children during their early years; this product contains both of these bacteria,
In a study conducted by Whorwell it was demonstrated that probiotic bacteria strain B.infantis 35624 encouraged more frequent bowel movements than in children that were given the placebo6.
B.infantis is one of the dominant species found in the gut of healthy children
7) Lactobacillus casei shirota
You may be more familiar with this strain of bacteria in some of the yogurt drinks available on the supermarket shelf. A study conducted by the Universityof Naplestested the effects of Lactobacillus casei shirota on 44 infants experiencing chronic constipation10.
In another random placebo controlled trial blinded, 70 chronic constipation adult patients were either treated with a yogurt drink or a placebo. After two weeks, the patients had sharply reduced constipation5.
We have previously written about constipation in children which you can read about here.
The additional benefits of prebiotics
In addition to probiotics, it is worth mentioning that prebiotics may also be helpful in relieving constipation. Prebiotics act as a food source for the probiotics and help to stimulate the activity of beneficial colonic bacteria. They are thought to have a small laxative effect. A useful combination of Bifidobacterium lactis BB-12 probiotic and prebiotics can be found in OptiBac Probiotics Bifidobacteria & fibre.
OptiBac Probiotics Bifidobacteria & fibre combines the well researched BB-12 strains & prebiotics to relieve constipation
Dietary sources of probiotic bacteria
There are also certain foods you can include in your diet which may help to boost levels of beneficial bacteria and support digestive health such as probiotic foods including natural live yogurt and fermented foods (e.g sauerkraut and kimchi) which are rich in Lactobacillus bacteria. Click here to read about foods that can relieve constipation.
You may also like to read more about Natural Remedies for constipation.
1. Matsumoto, M. et al. (2001) Effect of Yoghurt with Bifidobacterium lactis Bb-12® in Improving Fecal Microflora and Defecation of Healthy Volunteers. Journal of Intestinal Microbiology; 14(2): pp. 97-102
2. Pitkala, K.H et al. (2007) Fermented cereal with specific bifidobacteria normalizes bowel movements in elderly nursing home residents. A randomized, controlled trial. Journal of Nutritional Health and Aging; 11(4): pp.305-311.
3. Nishida, S. et al. (2004) Effect of Yogurt Containing Bifidobacterium lactis BB-12® on Improvement of Defecation and Fecal Microflora of Healthy Female Adults. Milk Science; 53(2): pp. 71-80
4. Murakami, T. et al (2006) Safety and effect of yoghurt containing Bifidobacterium lactis BB-12®on improvement of defecation and faecal microflora in h healthy volunteers. Journal of Nutritional Food; 9 pp. 15-26
5. Koebnick C, Wagner I, Leitzmann P, Stern U, Zunft H. Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation. Can J Gastroenterol 2003; 17:655–659.
6. Whorwell P, Altringer L, Morel J, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol 2006;101:1581–1590.
7. Bouvier M, Meance S, Bouley C, Berta J, Grimaud J. Effects of consumption of milk fermented by the probiotic strain Bifidobacterium animalis DN-173 010 on colonic transit times in healthy humans. Biosci Microflor 2001; 202:43–48.
8. Marteau P, Cuillerier E, Meance S et al. 2001. Bifidobacterium animalis strain DN-173 010 shortens the colonic transit time in healthy women: a double-blind, randomized, controlled study. 15 Oct 2001.
9. Tabbers MMC, A.; Roseboom, M. G.; Crastes, N.; Perrin, C.; Reitsma, J. B.; Norbruis, O.; Szajewska, H.; Benninga, M. A. Fermented milk containing Bifidobacterium lactis DN-173 010 in childhood constipation: a randomized, double-blind, controlled trial. Pediatrics 2 011; 127(6): e1392-1399
10. Bu LN, Chang MH, Ni YH, Chen HL, Cheng CC. Lactobacillus casei rhamnosus Lcr35 in children with chronic constipation. Pediatr Int 2007; 49: 485-90.
11. Colecchia A, Vestito A, La Rocca A, Pasqui F, Nikiforaki A, Festi D, Symbiotic Study Group. Effect of a symbiotic preparation on the clinical manifestations of irritable bowel syndrome, constipation-variant. Results of an open, uncontrolled multicenter study. Minerva Gastroenterologica e Dietologica
Banaszkiewicz A1, Szajewska H.J Ineffectiveness of Lactobacillus GG as an adjunct to lactulose for the treatment of constipation in children: a double-blind, placebo-controlled randomized trial. Pediatr. 2005 Mar;146(3):364-9.
13. Niedzielin K, Kordecki H, Birkenfeld B.A. Controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2001 Oct;13(10):1143-7.
14. Higashikawa F, Noda M, Awaya T, Nomura K, Oku H, Sugiyama M. Improvement of constipation and liver function by plant-derived lactic acid bacteria: a double-blind, randomized trial. Nutrition. 2010 Apr;26(4):367-74. doi: 10.1016/j.nut.2009.05.008. Epub 2009 Jul 22.
15. Tabbers M, Chmielewska A, Roseboom M, Crastes N. Fermented milk containing Bifidobacterium lactis DN-173 010 in childhood constipation: a randomized, double-blind, controlled trial. Paediatrics 06/2011; 127(6):e1392-9.