Constipation can be referred to as a condition of the digestive system wherein bowel movements are not frequent resulting in painful defecation. In most cases this might be a result of slower bowel movements as a result of which the colon absorbs too much of water from the food and turn it dry and difficult to pass out. Constipation may be a result of a low fibre diet, low liquid intake or dieting. Probiotics have been used as a remedy against constipation. Doctors at University of Maryland Medical Center suggest use of probiotics in combating constipation.
History of Probiotic Use In Constipation:
The use of probiotics in the treatment and relief of constipation has a long history. Some of the first clinical trials carried out with lactobacilli were related to their effect on constipation. In 1922, Rettger & Cheplin were amongst the first to recommend the use of acidophilus milk to adults with constipation problem. Similar results were found in 1933 and 1935 by a group of researchers including Weinstein, Weiss, Rettger and Levy. The results were substantiated by the works of Graf and Alm et al. (1983).
Constipation Treatment With Probiotics:
Constipation has reportedly been more common in elderly people. The use of probiotics employed in the treatment of constipation has resulted in the increase in number of bowel movements or a decrease in transit time in controlled studies. In a published report in the Annals of nutrition and metabolism by the group of Ouwehand, it was observed that the subjects who received L. rhamnosus/P. freudenreichii-supplemented juice showed an increase of 24% in defecation rate alongwith a significant decrease in fecal azoreductase activity. Probiotics seem to be the answer to childhood constipation problems as well. In a pilot experiment carried out by Bekkali et al., children in the age group of 6-14 received a daily mix of a probiotic mixture that contained different strains of Lactobacilli or Bifidobacteria. The results of the study which was published in the Nutrition journal proved that a probiotic mixture presented to the constipated children increased the frequency of bowel movements with a defecation rate less than 3 times per week as also a decrease in fecal incontinence episode numbers.
Role Of Probiotics In Constipation Treatment:
Multiple reasons are involved to make the use of probiotics as a therapeutic intervention in the treatment of constipation a reality. There are data that demonstrates differences in the level of microbiota within the intestine between healthy individuals and patients with chronic cases of constipation according to a report in Acta Pediatrica. The changes encountered include an increased number of Bifidobacteria and Clostridia. The intestinal flora composition changes may result in alteration of metabolites of bacterial fermentation which results in increased intestinal mobility and a shortened transit-time. In a study that involved the administration of B. lactis DN-173 010 to the healthy and constipated subjects resulted in improved colonic transit times in both the categories under study.
Probiotics Lowers The Colonic-Transit:
Probiotics can lower the pH in the colon. Short-chain fatty acids are the by-products of metabolism of probiotic bacteria and are the prime reason for the lowering in pH of the colon. Improved peristalsis is noticed in the colon with a decrease in pH which might consequently decrease the colonic transit time. For this same reason, Lactic acid bacteria improve the intestinal mobility and relieve constipation. The laxative prebiotic lactulose is not attacked by the human disaccharidases but the probiotic Bifidobacteria can thrive on it in the colon where it is metabolised into smaller fragments which creates an osmotic effect. Although any major conclusion cannot be drawn between the osmolarity achieved and the ease of colonic transit as that would require larger controlled studies involving the use of probiotics and prebiotics other than lactulose.
But short chain acids like lactic acid are also formed during the fermentation of lactulose, with subsequent reduction in colon pH and the modulation of the microflora. Lactulose on the other hand provides growth advantage to Lactic acid bacteria and Bifidobacteria and to be more precise Lactobacillus acidophilus in the colon. Lactulose promotes majorly a Gram-positive fecal microflora in animal studies but its larger dosage may result in transient diarrhoea. In an important study by Chmielewska’s group it was observed that a combination of lactulose with Lactic acid bacteria relieved human volunteers of constipation quite effectively. The data from this study were published in the World Journal of Gastroenterology in 2010. It was further established that the same prebiotic-probiotic cocktail in a fermented diary product can normalize radiotherapy-associated diarrhoea and intestinal side effects. The use of lactulose in normalizing the intestinal microbiota and stabilizing the integrity of the mucus has beneficial effects in intestinal disorders. According to the work of Jouet et al., this beneficial effect can be attributed to a number of factors including an overall increase in the mass of bacteria or stool water that causes quick transit.
Present day constipation therapy requires in addition to a high fibre diet containing whole grain products, fruits and vegetables, the administration of complete probiotic food products like Probacto within the treatment regime. A number of other poorly absorbed storage carbohydrates have been tried for their laxative effect that exerts important effects on gut microbiota but their precise mode of action is not that well defined than it is for lactulose which hinders their use in the same prebiotic-probiotic combinations. Future studies should revolve around the identification, characterization and utilization of other alternative prebiotic products to lactulose. Similarly, attention should also be focussed on the isolation and standardization of other strains of probiotic bacteria that can act in combination with lactulose or similar prebiotic products. The utility of fermented milk products and Lactic acid bacteria in the improvement of constipation has only been probed in a fewer studies. More efforts are needed in this aspect as well. Furthermore, the probiotic intake seems to improve the general well being of the recipient. The Daily Mail reports on 25 May, 2010 that probiotics can be used to treat cases of constipation.