Probiotics and constipation: mechanisms of action, evidence for effectiveness and utilisation by patients and healthcare professionals

Abstract

The aim of this narrative review is to assess and present evidence on the mechanisms of action of probiotics in constipation, their effectiveness and their utilisation by patients and healthcare professionals. Chronic constipation is a common bothersome disorder that has a considerable impact on patients' quality of life. Probiotics have been increasingly investigated for their effectiveness in various disorders, including chronic constipation. Probiotics may affect gut motility and constipation through their impact on the gut microbiota and fermentation, the central and enteric nervous system and the immune system. However, evidence for the effectiveness of probiotics in the management of constipation remains varied, with some strains demonstrating improvements, while others show no effect. Despite the uncertainty in evidence and the fact that the majority of healthcare professionals do not recommend probiotics for constipation, an increased prevalence of probiotic use by people with constipation has been shown. Therefore, there is a need for public health strategies to inform the public about where strong evidence of probiotic effectiveness exist, and where evidence is still weak. Education of healthcare professionals on the increased utilisation of probiotics for constipation by the public and on current evidence for the effectiveness of specific strains is also required.

Chronic constipation in adults: Contemporary perspectives and clinical challenges. 2: Conservative, behavioural, medical and surgical treatment

“…There are several animal and human studies suggesting that probiotics may regulate gut motility and improve constipation-related outcomes via their impact on the gut microbiota and their by-products, and on the nervous and immune system [63][64][65].…”

“…There are several animal and human studies suggesting that probiotics may regulate gut motility and improve constipation‐related outcomes via their impact on the gut microbiota and their by‐products, and on the nervous and immune system [63–65]. Systematic reviews have demonstrated variable results for different probiotic strains in both children [66, 67] and adults [68].…”

Pediococcus acidilactici Strains Improve Constipation Symptoms and Regulate Intestinal Flora in Mice

“…Irritant drugs have limited efficacy and serious adverse effects ( Bharucha et al, 2017 ; Luthra et al, 2019 ). Therefore, oral supplementation with probiotics (safe and long-acting) is attracting considerable interest among gastrointestinal physicians and researchers ( Dimidi et al, 2020 ).…”

Lactobacillus Reuteri DSM 17938 (Limosilactobacillus reuteri) in Diarrhea and Constipation: Two Sides of the Same Coin?

“…The authors included 56 patients with constipation, randomized to receive L. reuteri for 105 days. Dimidi et al [ 43 , 44 ], in their review on the mechanisms of action of probiotics on the gut motility and constipation, and the interaction with the gastrointestinal microbiota, demonstrated that L. reuteri interacts with the gut-brain axis and modulates the afferent sensory nerves that influence gut motility. Moreover, it involves the enteric nervous system, increasing the excitability of myenteric neurons in rats through action on the 5-HT pathways.…”