Constipation

Health A-Z

Gastroesophageal reflux disease (GERD)

Overview

Physiological conditions such as reduced cerebral blood flow and high levels of inflammation⁵
Mental health conditions such as depression and anxiety⁴
Long COVID syndrome³
Medications for pain and sleep⁶
Chronic sleep disturbances
Stressful lifestyle
Ageing

Symptoms and signs

Causes and risk factors

Extrinsic factors⁶

Low fibre intake
Insufficient hydration
Reduced mobility
Medications

Intrinsic factors⁶

Pelvic floor dysfunction
Slow colon transit time

Causes and risk factors

Extrinsic factors⁶

Low fibre intake
Insufficient hydration
Reduced mobility
Medications

Intrinsic factors⁶

Pelvic floor dysfunction
Slow colon transit time

Supplement recommendations

Probiotics

Mechanism of action
The mechanisms of action of probiotics include direct interaction with intestinal microbiota to modify its composition, improving gut barrier function and mucosal immunity, reducing mucosal permeability and competitive exclusion which reduces the colonisation of pathogenic bacteria⁷,⁸,⁹.

Benifits

Probiotics produce short-chain fatty acids through the fermentation process which promotes osmotic stimulation. It increases the secretion of water and electrolytes thereby softening the stools. Softer stools and improved intestinal peristalsis will likely relieve the symptoms of constipation. Clinical research showed that daily intake of 30 billion CFUs multi-strain probiotic containing L. acidophilus, L. casei, L. lactis, Bifidobacterium bifidum, Bifidobacterium longum and Bifidobacterium infantis twice for 7 days helps to improve bowel movement among adults with chronic constipation compared to placebo¹⁰/

Gastrointestinal health

Probiotics play an important role in maintaining intestinal microbiota homeostasis and inducing systemic protective responses. It blocks the adherence of pathogens and toxins to the intestinal epithelium by secreting bactericidal substances¹¹. On top of that, probiotics also facilitate shortchain fatty acids production in the gastrointestinal tractwhich helps to regulate pH and inhibit the activation of NFB macrophages that can cause inflammatory bowel diseases¹². A meta-analysis showed probiotics reduce irritable bowel syndrome and abdominal pain after 8 to 10 weeks of consumption¹³.

Recommended dosage
There is currently no established effective probiotic dosage because it can be affected by species, dose and duration of therapy depending on the clinical indication. The concentration of single strain bacteria is recommended to be >1 billion CFU to ensure effectiveness unless with clinical support¹⁴.

Supplement recommendations

Magnesium

Mechanism of action
Magnesium salts increase the osmotic pressure of the intestinal lumen fluid, thereby promoting the transfer of water to the intestinal lumen and increasing the water content and volume of the stool. In addition, the swollen stool stimulates the intestinal wall and intestinal propulsive motor activity¹⁵.

Benifits

Constipation

Magnesium is known to cause relaxation of the muscles lining the colon walls, which allows for smoother wall contractions. These smoother wall contractions allow for effective pushing of stool. Magnesium also attracts water into the colon making stool softer and easier to pass. In a crosssectional study of 3835 female Japanese students aged 18 to 20 years, constipation was not associated with low fiber or low water intake from foods but was
associated with a low intake of magnesium¹⁶.

Recommended dosage
Recommended dietary allowances (RDAs) for magnesium¹⁷

Supplement recommendations

Konjac

Mechanism of action
Like other forms of dietary fiber, konjac glucomannan is considered a “bulk-forming laxative.” Glucomannan promotes a larger, bulkier stool that passes through the colon more easily, requiring less pressure and subsequently less straining to expel¹⁸.

Benifits

Constipation

Studies shown that glucomannan may provide relief in constipation through the improvement of probiotic bacteria counts in faeces (colonicecology) after daily supplementation of 1.5g of konjac glucomannan for 21 days. Bowel movement function was increased by 30%¹⁹. The mean defecation frequency and dry faecal mass increased due to the presence of plant and soluble materials from supplementation of konjac glucomannan²⁰.

Inflammatory bowel disease (IBD)

Daily consumption of konjac glucomannan hydrolysates was shown to enhance capacity to bind pathogens and prevent this from binding the gut’s lining, stimulating topical healing, regulating immunity and ability to form systemic immune responses among healthy people with IBD and associated gut conditions. It is function as soluble dietary fibre as well as prebiotic²¹.

Recommended dosage²²
Konjac is normally added to foods as a thickening agent and dietary fiber source. Typical doses used as treatment by adults is ranging from 3g to 4g daily for up to 3 months.

Diet & lifestyle recommendations

Higher dietary fibre intake (fruits, legumes, and vegetables)²³
Drink plenty of fluid²³
Exercise²⁴
Do not ignore the urge to pass stool²⁴
Create a regular schedule for bowel movements, especially after a meal²⁴

References :

Maria Vazquez Roque, Ernest P Bouras. (2015). Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging, 919–930.
Amy E. Foxx-Orenstein, Meredythe A. McNally, Suwebatu T. Odunsi. (2018). Update on constipation: One treatment does not fit all. Cleveland Clinic Journal of Medicine , 813-824.
National Institute of Diabetes and Digestive and Kidney Diseases. (2013). Constipation. National Institute of Diabetes and Digestive and Kidney Diseases.
Mayo Clinic. (2023). Constipation. Retrieved from https://www.mayoclinic.org/diseasesconditions/ constipation/symptoms-causes/syc-20354253
J. F. Johanson, J. Kralstein. (2007). Chronic constipation: a survey of the patient perspective. USA: Blackwell Publishing Ltd.
Lawrence Leung, Taylor Riutta, Jyoti Kotecha, Walter Rosser . (2011). Chronic Constipation: An Evidence-Based Review. Journal of the American Board of Family Medicine, 437-451.
Schulz, C., Koch, N., Schütte, K., Pieper, D. H., & Malfertheiner, P. (2015). H. pylori and its modulation of gastrointestinal microbiota. Journal of digestive diseases, 16(3), 109–117. https://doi.org/10.1111/1751-2980.12233
Puram, S., Suh, H. C., Kim, S. U., Bethapudi, B., Joseph, J. A., Agarwal, A., & Kudiganti, V. (2013). Effect of GutGard in the Management of Helicobacter pylori: A Randomized Double Blind Placebo Controlled Study. Evidence-based complementary and alternative medicine : eCAM, 2013, 263805. https://doi.org/10.1155/2013/263805
Weinland, S. R., & Drossman, D. A. (2013). Psychological factors and treatments in irritable bowel syndrome. Irritable Bowel Syndrome, 183-213. https://doi.org/10.1002/9781118444689.ch10
Jayasimhan, S., Yap, N.Y., Roest, Y., et al. (2013). Efficacy of microbial cell preparation in improving chronic constipation: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition, 32: 928-934. http://dx.doi.org/10.1016/j.clnu.2013.03.004
Yan, F., & Polk, D. B. (2011). Probiotics and immune health. Current opinion in gastroenterology, 27(6), 496–501. https://doi.org/10.1097/MOG.0b013e32834baa4d
Markowiak-Kopeć, P., & Śliżewska, K. (2020). The Effect of Probiotics on the Production of Short-Chain Fatty Acids by Human Intestinal Microbiome. Nutrients, 12(4), 1107. https://doi.org/10.3390/nu12041107
Didari, T., Mozaffari, S., Nikfar, S. & Abdollahi, M. (2015). Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World Journal of Gastroenterol, 21(10): 3072-3084. https://doi.org/10.3748/wjg.v21.i10.3072
Braun L, Cohen M. Herbs and Natural supplements. Ebook 4th edition. Chatswood: Elsevier 2015 pp.771-796
Hideki Mori, Jan Tack, Hidekazu Suzuki . (2021). Magnesium Oxide in Constipation. Nutrients, 421.
Renea L. Beckstrand, Jann S. Pickens . (2011, April 17). Beneficial Effects of Magnesium Supplementation. Retrieved from https://journals.sagepub.com/doi/full/10.1177/2156587211401746
National Institute of Health, Office of Dietary Supplements. (2022). Magnesium. Retrieved from https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#en1
PeachHealth. (2023). Glucomannan. Retrieved from https://www.peacehealth.org/medicaltopics/id/hn-2852001#:~:text=Like%20other%20forms%20of%20dietary,subsequently%20less%20straining%E2%80%94to%20expel.
Chen, H. L., Cheng, H. C., Wu, W. T., Liu, Y. J., & Liu, S. Y. (2008). Supplementation of konjac glucomannan into a low-fiber Chinese diet promoted bowel movement and improved colonic ecology in constipated adults: a placebo-controlled, diet-controlled trial. Journal of the American College of Nutrition, 27(1), 102–108.https://doi.org/10.1080/07315724.2008.10719681
Chen, Hsiao-ling & Cheng, Han-Chung & Liu, Yann-Jiu & Liu, Su-Yuan & Wu, Wen-Tze. (2006). Konjac acts as a natural laxative by increasing stool bulk and improving colonic ecology in healthy adults. Nutrition (Burbank, Los Angeles County, Calif.). 22.1112-9. 10.1016/j.nut.2006.08.009
Suwannaporn, P., Thepwong, K., Tester, R.F., Al-Ghazzewi, F.H., Piggott, J.R., Shen, N., Chen, Z., Chen, F., Yang, J., Zhang, D., & Tang, M. (2013). Tolerance and nutritional therapy of dietary fibre from konjac glucomannan hydrolysates for patients with inflammatory bowel disease (IBD). Bioactive Carbohydrates and Dietary Fibre, 2, 93-98.WebMD LLC. (2022). Glucomannan-uses, side effects, and more. Retrieved from https://www.webmd.com/vitamins/ai/ingredientmono-205/glucomannan Sun Hwan Bae. (2014). Diets for Constipation. Pediatr Gastroenterol Hepatol Nutr, 203-208.
WebMD LLC. (2022). Glucomannan-uses, side effects, and more. Retrieved from https://www.webmd.com/vitamins/ai/ingredientmono-205/glucomannan
Sun Hwan Bae. (2014). Diets for Constipation. Pediatr Gastroenterol Hepatol Nutr, 203-208.
S anjoaquin MA, Appleby PN, Spencer EA, Key TJ. Nutrition and lifestyle in relation to bowel movement frequency: a cross-sectional study of 20 630 men and women in EPIC–Oxford. Pub health Nutr 2004;7(1):77-83

The material is prepared for informational purposes only and should not be construed as a piece of personal medical advice. Owing to each person’s varying health needs, a physician should be consulted before acting on any information provided in this material. Although every effort is made to ensure that this material is accurate, it is compiled for internal use only and should not be considered definitive. Neither VitaHealth nor its employees, or information providers shall be responsible or liable for any errors, inaccuracies, or other defects in the information contained in this publication.