Approximately 12% of the global population experiences constipation at some point in their lives1. Constipation is characterized by the slow transit of stool through the colon, which can lead to infrequent and/or hard stools. It is a common complaint in irritable bowel syndrome (IBS) patients, but it can also be caused by other factors like low-fiber diets, pregnancy or old age. The main treatment for constipation is increasing dietary fiber. However, fiber may not work for everyone.
Research shows that another viable treatment option is probiotics. Studies on constipation-predominant IBS (IBS-C) show that patients have changes in their gut flora2. This suggests that manipulating the microbiota may provide relief. Probiotics is one way to do this.
I’ve now compiled the top five probiotics for constipation. Much like my older post on probiotics for IBS, I searched the literature for clinical trials attempting to treat constipation with probiotics. This time, I unearthed a total of 37 separate clinical studies. Of these studies, a total of 30 recorded positive results. Factors that weighed most heavily were the total number of double-blind studies performed for the probiotic, the number of patients tested and the significance of the results.
1. Bifidobacterium lactis DN-173 010
The number one position goes to B. lactis DN-173 010. Despite its scientific name, most of you probably are already familiar with it. It is the key probiotic species found in Dannon’s Activia, but they call it Bifidus Regularis. This species has been tested multiple times in three blinded studies3-5 and two open-label studies6, 7 with good results. The largest blinded study was performed in 267 patients with IBS-C. Patients were given the yogurt drink daily and noted less discomfort after three weeks. After six weeks, a significantly increased stool frequency was observed4. While the results for adult constipation look good; in blinded trial with constipated children, B. lactis DN-173 010 wasn’t helpful8. This is something to keep in mind when looking for treatment options for kids.
2. VSL#3 formula
The second best probiotic according to research is VSL#3. This probiotic mix contains eight different strains and is so potent that it is considered a medical food. While it can be bought on Amazon, it is suggested that it be taken in consultation with a health practitioner. It has been examined in one large blinded study with 243 elderly patients9 and in an open-label trial with constipated pregnant women10. In the study with the older patients, they found that the usage of laxatives was significantly reduced. While the pregnancy study was actually focused on looking at the effects of VSL#3 on vaginal infections. The researchers noted that, besides helping the infections, the formula significantly treated constipation as well.
Interestingly, the second runner up strain is also from the B. lactis species. The Danish company Chr. Hansen owns this particular strain, and it can be found in a variety of products. This strain has been investigated in two blinded trials for constipation: one with IBS patients11 and one with constipated elderly patients12. The reason that this strain is number three, and not two, is that the IBS study combined it with acacia fiber. Thus, it is difficult to conclude that this strain is just as effective on its own. In any case, combined with acacia fiber the results were very good; patients saw significant improvements in their symptoms. This strain can be found in TruBiotics daily probiotic supplement, and it is also found in the supermarket yogurt, La Yogurt.
4. Lactobacillus casei Shirota
Fourth place goes to the bacterial strain found in the yogurt drink Yakult. This has been tested for constipation in one blinded study13 and two open-label studies14, 15. In the blinded trial, 70 chronic constipation patients were either treated with Yakult or a placebo. Participants filled in questionnaires and were examined weekly. After two weeks, the patients had sharply reduced constipation. However, the probiotic did not influence bloating or gas. Lactobacillus casei Shirota was also useful for Parkinson’s patients with constipation in an open-label trial14.
5. Bifidobacterium longum
The last in the list is the species, Bifidobacterium longum. These strains were tested often in small studies with good results. This species was examined in a total of five studies: three blinded12, 16, 17 and two open-label18, 19. Success was seen in constipated elderly patients12, adults with chronic constipation16, 18 and IBS-C patients19. It was able to prevent constipation in babies17. Given the wide variety of strains tested (BL999, W11 and W23), I couldn’t place it higher in my list. However, considering the number of studies, my gut feeling says that B. longum strains can be very helpful. This species can be found in a multitude of products.
Thankfully, the majority of probiotics are classified as GRAS (generally recognized as safe). Still, it is wise to consult your practitioner before starting any kind of self-treatment, especially if your condition is undiagnosed. Also, keep in mind, that group averages were compared in these studies. This means that while some may have seen great improvements, others may have not seen anything at all after treatment.
I wish you the best of health.
Please note that the product links included are my Amazon affiliate links.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.
1. Wikipedia – Constipation. http://en.wikipedia.org/wiki/Constipation, Accessed November 14, 2013.
2. Chassard C, Dapoigny M, Scott KP, Crouzet L, Del’homme C, Marquet P et al. Functional dysbiosis within the gut microbiota of patients with constipated-irritable bowel syndrome. Aliment Pharmacol Ther 2012; 35(7): 828-838.
3. Agrawal AH, L. A.; Morris, J.; Reilly, B.; Guyonnet, D.; Goupil Feuillerat, N.; Schlumberger, A.; Jakob, S.; Whorwell, P. J. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2009; 29(1): 104-114.
4. Guyonnet DC, O.; Ducrotte, P.; Picard, C.; Mouret, M.; Mercier, C. H.; Matuchansky, C. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther 2007; 26(3): 475-486.
5. Roberts LMM, D.; Holder, R.; Wilson, S.; Hobbs, F. D. A randomised controlled trial of a probiotic ‘functional food’ in the management of irritable bowel syndrome. BMC Gastroenterol 2013; 13: 45.
6. De Paula JAC, E.; Weill, R. Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation. Acta Gastroenterol Latinoam 2008; 38(1): 16-25.
7. Yang YXH, M.; Hu, G.; Wei, J.; Pages, P.; Yang, X. H.; Bourdu-Naturel, S. Effect of a fermented milk containing Bifidobacterium lactis DN-173010 on Chinese constipated women. World J Gastroenterol 2008; 14(40): 6237-6243.
8. 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 2011; 127(6): e1392-1399.
9. Zaharoni HR, E.; Vardi, H.; Friger, M.; Bolotin, A.; Shahar, D. R. Probiotics improve bowel movements in hospitalized elderly patients–the PROAGE study. J Nutr Health Aging 2011; 15(3): 215-220.
10. Facchinetti FD, G.; Pedretti, L.; Resasco, P.; Annessi, E.; Dodero, D. [The role of oral probiotic for bacterial vaginosis in pregnant women. A pilot study]. Minerva Ginecol 2013; 65(2): 215-221.
11. Min YWP, S. U.; Jang, Y. S.; Kim, Y. H.; Rhee, P. L.; Ko, S. H.; Joo, N.; Kim, S. I.; Kim, C. H.; Chang, D. K. Effect of composite yogurt enriched with acacia fiber and Bifidobacterium lactis. World J Gastroenterol 2012; 18(33): 4563-4569.
12. Pitkala KHS, T. E.; Finne Soveri, U. H.; Ouwehand, A. C.; Poussa, T.; Salminen, S. Fermented cereal with specific bifidobacteria normalizes bowel movements in elderly nursing home residents. A randomized, controlled trial. J Nutr Health Aging 2007; 11(4): 305-311.
13. Koebnick CW, I.; Leitzmann, P.; Stern, U.; Zunft, H. J. Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation. Can J Gastroenterol 2003; 17(11): 655-659.
14. Cassani EP, G.; Pezzoli, G.; Pusani, C.; Madio, C.; Iorio, L.; Barichella, M. Use of probiotics for the treatment of constipation in Parkinson’s disease patients. Minerva Gastroenterol Dietol 2011; 57(2): 117-121.
15. Sakai TM, H.; Ishikawa, E.; Oishi, K.; Kushiro, A. Fermented milk containing Lactobacillus casei strain Shirota reduces incidence of hard or lumpy stools in healthy population. Int J Food Sci Nutr 2011; 62(4): 423-430.
16. Guerra PVL, L. N.; Souza, T. C.; Mazochi, V.; Penna, F. J.; Silva, A. M.; Nicoli, J. R.; Guimaraes, E. V. Pediatric functional constipation treatment with Bifidobacterium-containing yogurt: a crossover, double-blind, controlled trial. World J Gastroenterol 2011; 17(34): 3916-3921.
17. Puccio GC, C.; Meli, F.; Rochat, F.; Grathwohl, D.; Steenhout, P. Clinical evaluation of a new starter formula for infants containing live Bifidobacterium longum BL999 and prebiotics. Nutrition 2007; 23(1): 1-8.
18. Amenta MC, M. T.; Di Fiore, P.; Venturini, I. Diet and chronic constipation. Benefits of oral supplementation with symbiotic zir fos (Bifidobacterium longum W11 + FOS Actilight). Acta Biomed 2006; 77(3): 157-162.
19. Colecchia AV, A.; La Rocca, A.; Pasqui, F.; Nikiforaki, A.; Festi, D. Effect of a symbiotic preparation on the clinical manifestations of irritable bowel syndrome, constipation-variant. Results of an open, uncontrolled multicenter study. Minerva Gastroenterol Dietol 2006; 52(4): 349-358.