What To Do If Probiotics Cause Constipation

Probiotics are microorganisms (healthy bacteria) that live within the human body, particularly the gastrointestinal (GI) tract. Examples of common types of probiotics present in foods and dietary supplements include Lactobacillus, Bifidobacterium, and Saccharomyces. Health benefits linked to probiotics may include supporting gut, skin, oral, and vaginal health. 

However, potential side effects, including constipation, may also be linked to probiotics. About 4 million people in the United States struggle with frequent constipation, a common GI complaint. The purpose of this article is to explore the issue of probiotics potentially contributing to constipation.

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Understanding the Connection Between Probiotics and Constipation

Probiotics and constipation are linked via the effects of probiotics on gastrointestinal health.

Mechanism of Action of Probiotics

Probiotics work in the gut by helping to maintain a balance of good and harmful bacteria. They may also support the body's defenses against harmful fungi, bacteria, parasites, and viruses. 

Probiotics can help manage the growth of harmful microorganisms in the GI tract. They produce bioactive metabolites, particularly short-chain fatty acids. 

Other mechanisms of action for probiotics may include:

• Toxin neutralization
• Enzymatic activity
• Bile salt formation
• Vitamin synthesis
• Immunomodulation
• Cytokine production
• Gut barrier reinforcement
• Reduced pH in the colon 

Probiotics may also affect the functioning of the nervous and endocrine systems.

Potential Causes of Constipation Due to Probiotics

Constipation is a potential side effect of taking probiotics in some people because of changes in gut microbiota composition, though probiotics are commonly used to support digestive health. Probiotics can help manage diarrhea or constipation when used appropriately. 

However, strain-specific effects on stool exist, as do individualized variations in responses to probiotics. Dosing and administration also play a role in whether or not an individual experiences constipation after taking probiotics. 

In fact, some people experience diarrhea, at least temporarily, after beginning a probiotic supplement regimen, particularly when ingesting probiotics in large doses. 

Identifying Symptoms and Diagnosis

Constipation increases the risk of troublesome health issues when not addressed.

Recognizing Constipation

Constipation is defined as infrequent or uncomfortable bowel movements that pass dry, hard stools (typically fewer than three times per week). However, because normal stool frequency varies from person to person, any less frequent or difficult bowel movements could indicate constipation. 

Occasional constipation comes and goes based on diet and other external factors, while chronic constipation involves having two or more symptoms for three months or longer. 

Diagnosing Probiotic-Induced Constipation

Diagnosing probiotic-induced constipation involves identifying the correlation between symptoms and probiotic use. Methods for accurate diagnoses include excluding other potential causes of constipation, such as:

• Low-fiber diets
• Some medications (antidepressants, opioids, calcium-channel blockers, etc.)
• Dehydration
• Lack of exercise
• Irritable bowel syndrome (IBS)
• Lifestyle habit changes
• Diabetes
• Thyroid problems
• Nerve dysfunction
• Pregnancy 
• Neurological conditions such as multiple sclerosis (MS) and Parkinson's disease 
• Laxative abuse
• Ignoring the urge to pass stool

Additional ways to diagnose probiotic-induced constipation include reviewing an individual's medical history and symptoms, completing a physical exam, and ordering gastrointestinal X-rays or other imaging procedures. A colonoscopy, sigmoidoscopy, colorectal transit studies, and other diagnostic GI tests may also be beneficial. 

Symptoms of constipation include:

• Infrequent bowel movements (fewer than three times weekly)
• Painful, difficult to pass bowel movements
• Lumpy, dry, hard stools
• Sluggishness
• Feeling uncomfortable, nauseous, or bloated
• Abdominal pain or cramping 
• Incomplete emptying after a bowel movement

Individuals can track their bowel patterns at home and report back to their healthcare provider. 

Managing Probiotic-Induced Constipation

Fortunately, probiotic-induced constipation can be effectively managed to support normal bowel movements. 

Immediate Steps for Relief

Ways to achieve immediate constipation symptom relief include:

• Drink more water (2-4 additional glasses daily)
• Eat fiber-rich foods (aim for at least 20-35 grams of fiber daily)
• Exercise more
• Try mild over-the-counter stool softeners, enemas, or laxatives
• Avoid caffeinated drinks
• Eliminate alcohol
• Avoid juices and sugar-sweetened beverages
• Eliminate highly processed foods
• Eat more vegetables, fruits, whole grains, legumes, nuts, and seeds
• Limit the intake of cheese, eggs, and meats
• Use over-the-counter fiber supplements if asked to by a healthcare provider 
• Don’t resist the urge to have a bowel movement. 
• Consider reducing doses of probiotic supplements

It’s helpful to keep a food diary to pinpoint specific foods linked to constipation. Avoid using laxatives for more than two weeks unless directed to by a healthcare provider. 

Adjusting Probiotic Regimen

Another way to reduce probiotic-induced constipation is to modify the dosage and frequency of probiotic use, particularly when taking probiotic supplements. Begin with low doses and gradually increase doses as needed to support optimal gut health.

Researchers define high doses of probiotics of at least 10¹⁰ colony-forming units (CFUs) and low doses as less than 10¹⁰ CFUs.

Studies show that single-strain probiotics appear to have greater beneficial effects on stool consistency, frequency, and constipation-related symptoms vs. multistrain probiotics. 

The researchers suggest that L. casei Shirota probiotics may help manage constipation symptoms, including straining, pain, abdominal discomfort, and incomplete feelings after defecation, while B. lactis offered beneficial effects on defecation frequency.

Combining probiotics with prebiotics (synbiotics) can also support gut health by reducing the risk of constipation.

Long-term Solutions and Preventive Measures

Long-term solutions and constipation prevention measures include:

Personalized Probiotic Therapy

To support gut health, it is highly beneficial to tailor probiotic supplement regimens based on individualized needs and gut microbiota profiles. Patients should consult with a healthcare provider for personalized advice. 

Monitoring and Adjusting Treatment

After beginning a probiotic regimen for diarrhea, constipation, or other gut health issues, follow up with a healthcare provider regularly and monitor any symptoms. Other potential side effects sometimes linked to probiotic use include:

• Nausea
• Flatulence
• Diarrhea
• Other stool changes
• Gas
• Bloating
• Abdominal pain
• Fatigue
• Coughing
• Unpleasant taste in the mouth
• Incontinence

Seek medical care if these or other unusual symptoms are severe, last more than a few days, or signs of an infection (fever, chills, etc.) develop. Providers should adjust probiotics treatment plans based on individualized patient responses. 

Lifestyle and Dietary Modifications

Adjusting diet and other lifestyle habits can reduce the risk of constipation or help manage it. Examples include:

• Consume fruits, vegetables, nuts, seeds, legumes, whole grains, and other High fiber foods
• Ask a healthcare provider about fiber supplementation
• Eat fermented foods naturally rich in probiotics
• Consume a balanced diet
• Eat at regular meal times
• Stay hydrated

Keep stress levels low and see a medical provider at the first sign of severe or ongoing constipation. 

When to Seek Professional Help

Seeking professional help for constipation reduces the risk of complications, such as hemorrhoids, anal fissures, fecal impactions, and rectal prolapse. 

Indicators for Medical Consultation

Indications for the need for a medical consultation include:

• Persistent or worsening symptoms
• Signs of severe gastrointestinal problems, such as nausea, diarrhea, vomiting, abdominal pain, or an infection
• Guidance regarding diagnostic tests and treatments

Consult with a healthcare provider with any concerns or questions about a probiotics treatment plan. 

Examples of Success Stories

Examples of success stories involving the management of constipation include:

• Researchers report that combinations of probiotic strains effectively supported symptoms of functional constipation by increasing bowel movement frequency and stool quality. 
• Studies also found that probiotics supported constipation outcomes in children, improving treatment success rates and bowel movement frequency. 
• Researchers have shown that taking probiotic supplements for four weeks or more effectively supports constipation symptoms in the elderly population. 

However, if taking probiotics seems to contribute to constipation, consult with a healthcare provider who might suggest altering other lifestyle habits, watchful waiting, or ingesting smaller amounts of probiotics. 

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Key Takeaways

• While probiotics are often used to support digestive health, probiotic-induced constipation is a concern, at least temporarily, because of changes in the gut microbiota.
• To support gut health, begin using probiotics under the supervision of a healthcare provider in small doses initially, gradually increasing doses if necessary.
• Providers should encourage probiotic use with informed caution.
• Keep an eye out for probiotic side effects, such as constipation, diarrhea, and other GI issues. 
• Individualized care and professional guidance are vital to effectively manage constipation potentially caused by probiotics.