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Chronic constipation is a common gastrointestinal disorder among middle-aged and older adults, often linked with reduced quality of life and limited treatment success owing to the side effects and modest efficacy of conventional therapies.
A 28-day multi-strain probiotic regimen significantly improves digestive health and constipation-related symptoms in middle-aged and older adults.
Chronic constipation is a common gastrointestinal disorder among middle-aged and older adults, often linked with reduced quality of life and limited treatment success owing to the side effects and modest efficacy of conventional therapies. Multi-strain probiotics have gained increasing attention as a safe and effective strategy for improving gut health and bowel function. This study examined the clinical efficacy and gut microbiome-related mechanisms of a 28-day probiotic supplementation regimen in adults with chronic constipation.
A randomized clinical trial was performed in adults diagnosed with chronic constipation. Overall, 132 participants were randomized to receive either a multi-strain probiotic supplement (n = 66) or a placebo (n = 66), while 100 participants completed the study per protocol (50 in each group). The key outcome was the number of weekly complete spontaneous bowel movements (CSBMs) after 28 days.
Secondary outcomes were changes in Bristol Stool Form Scale (BSFS), Patient Assessment of Constipation Symptoms (PAC-SYM), abdominal bloating scores, gut microbiota composition, fecal metabolomics, and short-chain fatty acid (SCFA) concentrations measured at baseline, day 14, and day 28. Responders were predefined as participants attaining ≥3 CSBMs per week with a rise of at least one CSBM from baseline at week 4.
After 28 days, those receiving probiotics illustrated significantly higher CSBM frequency compared with placebo. Probiotic supplementation also improved stool consistency, reduced constipation severity scores, and markedly decreased abdominal bloating. The responder rate was substantially greater with probiotics than with placebo (Table 1).
Gut microbiome analysis revealed increased microbial α-diversity and significant β-diversity separation between treatment groups at days 14 and 28. Beneficial bacterial genera, including Faecalibacterium, Lactobacillus, and Bifidobacterium, increased following probiotic use, whereas potentially harmful genera such as Enterobacter, Collinsella, and Oscillibacter decreased.
Metabolomic profiling showed enhanced SCFA biosynthesis pathways, particularly butanoate and propanoate metabolism. Targeted analyses confirmed markedly elevated fecal acetate and butyrate levels in the probiotic group at day 28. Positive correlations were noted between increases in Faecalibacterium, butyrate production, and CSBM improvement, while Enterobacter abundance showed a negative correlation with bowel movement frequency.
Mixed-strain probiotics appreciably improved bowel movement frequency, stool quality, abdominal bloating, and overall constipation symptoms in middle-aged and older adults with prolonged constipation. These benefits were linked with favorable modulation of the gut microbiota and enhanced SCFA production, supporting the therapeutic potential of probiotics as a safe nutritional strategy for chronic constipation care and gut health improvement.
Clinical Nutrition
A multi-strain probiotic formulation alleviates chronic constipation in middle-aged and older adults: A randomized, double-blind, placebo-controlled trial
Rui Xiao et al.
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