Are probiotics effective against constipation?

Nearone in five French people is concerned by the constipationwhether occasional or chronic, which makes it the most common transit disorder in France. Although benign, constipation is unpleasant, sometimes painful and can affect the daily lives of those who suffer from it. To what extent is the quality of the intestinal flora involved in slowing down transit? Can probiotics help?

Probiotics are living microorganisms (bacteria or yeast) which, when ingested in sufficient quantities, interact with the intestinal microbiota. Their action does not consist of sustainably “reconstructing” the intestinal flora, but rather of modulating it, enrich it et diversify it transiently.

Once ingested, they can influence the intestinal ecosystem by limiting the development of unwanted bacteria, but also by producing compounds such as organic acids which help modify the intestinal environment.

As the expert points out, the basis for maintaining a rich and diverse flora relies above all on diet and lifestyle : a varied dietrich in plants and fibers with prebiotic effect, fermented foods (natural probiotics) and low in ultra-processed products constitutes the first lever of action. THE sleepstress management and physical activity also play an important role in the balance of intestinal flora.

THE probiotics can nevertheless be an interesting helpparticularly in the event of an identified imbalance of the microbiota (dysbiosis), or in certain targeted situations. “But their effectiveness strongly depends on the strain of probiotic used andmatch with the person’s profile” underlines the nutrition therapist.
Taking a probiotic randomly, without precise indication or adaptation to the field, can thus be neutral at best, and sometimes not very relevant, even counterproductive if this disrupts an already fragile balance.

In medicine, the constipation does not just come down to insufficient bowel movement frequency. It is defined more broadly by a set of symptoms associating infrequent bowel movements — generally less than three per week — but also evacuation difficultiessuch as significant pushing efforts, hard stools, feeling of incomplete evacuation or the need for maneuvers to facilitate defecation.
Translation: you can have a bowel movement once every two or three days without being constipated, if the stools are of normal consistency and are not difficult to pass.

Intestinal transit is a major cog whose proper functioning depends on a set of factors that interact with each other. “Diet, hydration, physical activitythe proper functioning of the liver and the gallbladder, are the main players in good transit” recalls Sabrina Marnet-Letellier.
Diet plays a central rolenotably the quantity of fiber, which influences the volume and consistency of stools, as well as the presence of fats, which can modulate intestinal motility. Hydration is also essential, since a lack of water can slow down transit and lead to harder stools.
Added to this are lifestyle factors, such as physical activity, which naturally stimulates intestinal contractions, but also stress, which can disrupt digestive motility via the brain–intestine axis. Hepato-biliary functioning also intervenes, in particular via the production and emission of bile, which participates in the digestion of fats and indirectly influences the consistency of stools.

In this context, the intestinal microbiota – and therefore probiotics – represents only one factor among others.

Note also that probiotics are more likely to help in a recent constipation or linked to a change in lifestyle, because the digestive system is still “reversible” and the microbiota is more easily adjustable. “On the other hand, in the case of a chronic constipation installed for years, the disorder is often based on broader and lasting mechanisms, where probiotics are usually not enough alone to modify the transit” adds Sabrina Marnet-Letellier.
We cannot say that probiotics are laxative, but that they can contribute in certain specific cases to regulating abnormally slow or rapid transit.

In functional constipation, scientific data shows that there is no “universally recommended” probiotic, but rather some avenues that are more solid than others.
“In practice, I tend to recommend probiotics based on Lactobacillusnotably via formulas available in pharmacies such as Lactibiane Reference® (PiLeJe) or Smébiocta®” indicates Sabrina Marnet-Letellier.
The first combines several strains of probiotics, including Lactobacillus helveticus et Bifidobacterium longumin a logic of global support of the microbiota. The second is based on a single strain, Lactobacillus plants 299v, particularly studied for its interaction with the intestinal mucosa and its role in digestive balance.
These products do not target an “ideal” strain for constipation, but aim to modulate the intestinal ecosystem as a whole.
In other words, these recommendations reflect clinical experience and field logic more than a strict consensus based on a single probiotic strain validated in all studies.

Fermented foods are rich in probiotics because fermentation allows live microorganisms, such as certain bacteria, to multiply naturally in the food.

Remember that the first weapons to fight against a sluggish transit are diet and lifestyle!
First of all, these are the dietary fiber which must be honoured. “Whether they are soluble or insoluble, they feed the good bacteria and contribute (prebiotic effect) and improve transit by attracting water into the stools and making them more voluminous” underlines the expert. The foods richest in fiber to put on the menu regularly are: whole grains, legumes and of course fresh fruits and vegetables.
Drink plenty of water is also essential, for moisturize stools and improve the effectiveness of water-retaining dietary fiber.

Finally, l’physical activity regular calls for contraction of the intestinal muscles and boosts intestinal peristalsis which promotes the progression of the food bolus in the digestive tract. “Without these foundationsmake a probiotic treatment in the form of supplements may be useless or even poorly tolerated ” insists the nutrition therapist.
And if despite all these measures, transit remains abnormally slow, it is recommended to consult a health professional to verify that the constipation does not have an organic cause.

Common in infants and children, constipation often appears at key moments in development, such as dietary diversification or toilet training.
“In the very young, the strain Lactobacillus reuteri is often cited, because it has been studied in infants and seems to be able to improve the frequency of stools, with the added benefit of good tolerance” indicates Sabrina Marnet-Letellier. This is an option frequently used in practice, even if the results remain variable depending on the studies.
At theolder child, Lactobacillus rhamnosus GG is one of the best documented strains in pediatrics, for transit disorders, but it has mainly been studied for acute diarrhea or the prevention of digestive infections.
More broadly, certain strains of Bifidobacterium (notably B. lactis) have also been studied in children with sometimes positive results on transit.
But as in adults, probiotics must be offered in addition to health and diet measures. They are not a reference treatment in themselves, and the effects remain modest and inconsistent.

“Probiotics, even if poorly adapted, are not known to cause constipation,” says the nutrition therapist.
Their potential side effectscan be bloating or a transient digestive discomfortespecially at the start of treatment. But the main risk remains above all a lack of effectiveness when the strain used is not adapted to the situation.

For a long time, we almost systematically recommended taking probiotics after antibiotic therapy to “restore the flora”, damaged by the treatment.

In this context, it is yeast Saccharomyces boulardiimarketed in the form of‘Ultra-Yeast which is recommended. “Ultra-yeast can however be taken after antibiotic treatment if the problems persist” concludes the microbiota expert.