The intestinal microbiota plays a key role in health and disease, so promoting and maintaining its diversity and balance must become, beyond individual cases, a new therapeutic objective. Furthermore, modulating our microbiota is possible through lifestyle, which opens a world of possibilities for self-care. Specifically, there is scientific evidence of clinical results in the treatment of constipation.
Far from being a simple defecation pattern, for many people, constipation transcends the merely physical, and can significantly interfere with daily life and well-being. In addition to causing discomfort, abdominal bloating, gas or headache, it alters mood and produces irritability, so that up to 69% of people who experience it consider that it affects their work or school performance, as well as their social relationships. .
In this article we will refer to chronic functional constipation, also called idiopathic, for which a cause is not identified – such as an illness or the consumption of some medication – and in which at least two of the following clinical criteria must occur:
This is a bigger problem than it may seem, affecting 16% of the world’s population. In Spain, for example, the prevalence of constipation is between 15% and 20%, being higher in women than in men. It increases after the age of 60 – up to 30-40% – and it does so especially among institutionalized older people, that is, those who live in residences.
In a context of increasing life expectancy, this fact suggests an increase in its incidence in the coming years, with a great impact on the quality of life related to health and the resulting socioeconomic burden.
Currently, constipation accounts for 2.5% of primary care consultations and 21% of specialized digestive system consultations, according to data from the Spanish Society of Digestive Pathology.
Its negative impact on quality of life is comparable to that of other chronic diseases such as dermatitis, chronic allergies, depression, diabetes or musculoskeletal diseases such as arthritis or osteoporosis and its effects on mental health are considered to be even greater. serious than its physical consequences.
However, despite its great impact on daily life, only a small proportion of patients seek health care. Those affected often turn to over-the-counter medications and experience, in the long term, a reduction in health-related quality of life.
Typically, non-pharmacological treatment advice is based on exercise, hydration and increasing dietary fiber intake. However, compliance with these recommendations is low, and even when they are carried out, results are not always achieved. This results in high health expenditure on laxatives and/or enemas, complementary examinations such as abdominal x-rays or colonoscopies, the admission of patients to hospital centers (especially in elderly people) and the treatment of associated complications.
Constipation involves a slowing down of intestinal transit so that the expulsion of inefficient waste after eating food can last an average of 72 hours. These food remains remain in the intestine for longer, which favors the activation of inflammatory mechanisms that, in the long term, can even generate cellular mutations.
The classic recommendation to increase dietary fiber consumption – along with adequate hydration and physical activity – is based on its ability to directly affect gastrointestinal motility and, therefore, accelerate intestinal transit.
The available scientific knowledge invites us to integrate microbiota modulation into this classical approach. Although a pathophysiological cause of chronic idiopathic or functional constipation has not been identified, the existence of an imbalance in the intestinal microbiota (dysbiosis) in people who present it is known.
This dysbiosis is characterized by a decrease in the bacteria Bifidobacterium and Lactobacillus, which promote motility, and an increase in microorganisms with inflammatory potential such as Clostridium, which contributes to the symptoms of constipation.
Modulation of the microbiota (to restore microbial harmony) through biotics has been shown to be effective in the treatment of chronic constipation, improving both defecation frequency and stool consistency and presenting few side effects, making it an interesting therapeutic alternative.
Modulation of the microbiota aimed at improving constipation can be achieved through:
According to various studies, the effects of certain probiotic strains remain even after stopping their administration. This turns the new microbial approach into a therapeutic strategy with enormous potential, as it enables safe, sustainable and easy-to-compliance interventions.
This article was originally published on The Conversation.
Esther Martínez Migue is director of the Nursing Degree at the Faculty of Life and Natural Sciences, at the Nebrija University; and Silvia Gómez Senent, is a Digestive System doctor and director of the Master’s Degree in Human Microbiota, as well as a professor in the Nursing Degree, at the same university.
