Fullscript Academy

Chronic difficulties with infrequent bowel movements are one of the most common gastrointestinal disorders. (4) According to a systematic review published in 2011, median global prevalence in the general population is roughly 16%. (16) 

Notably, a recent survey found that of Americans with constipation, only 37.6% had a discussion about their symptoms. (19) Gastrointestinal health greatly impacts quality of life, and chronic constipation decreases both mental and physical aspects of it. (3) 

The protocol presented below suggests ingredients with demonstrated effectiveness for a variety of factors associated with infrequent and/or hard stools. 

Inulin

12-15 g per day, for a minimum of 4 weeks (11)(14)

• A meta-analysis found inulin to be effective in improving stool frequency and consistency according to the bristol scale (6) 
• Inulin supplementation increased stool frequency to a median of 4 per week (3 per week in placebo) in healthy adults with constipation; stool consistency softened and overall satisfaction increased (14)
• Elderly volunteers supplemented with inulin experienced decreased difficulty with defecation; stool analysis demonstrated an increase in bifidobacteria as well as total fecal bacterial count (11)
• Children given 2 g twice per day of Orafti® inulin-type fructans for 6 weeks experienced softened stool consistency as shown by an increase from 2.2 to 2.6 on modified bristol scale for children (5)

1-10 billion CFU, total per day, minimum 28 days (8)(7) 

• Adults with functional constipation having fewer than 3 bowel movements per week experienced an increased number of bowel movements per week when supplemented with 1 billion or 10 billion cfu per day of Bifidobacterium animalis subsp. lactis HN019 compared to placebo, as well as decreasing the degree of strain to pass stool (8) 
• Probiotics improved constipation by 10-40% compared to placebo in a systematic review of constipation in elderly people; notably the most commonly tested strain of probiotic was bifidobacterium longum (12)
• Irritable bowel syndrome-primary constipation (IBS-C) and functional constipation patients improved stool consistency as demonstrated by bristol stool scale, and increased quality of life at weeks 4 and 8 when supplemented with 300 million CFU/g Streptococcus thermophilus MG510 and 100 million CFU/g Lactobacillus plantarum LRCC5193 compared to placebo (23)
• Mixed probiotic formulation decreased flatulence and decreased the mean AUC of all symptoms in adults with constipation compared to placebo (1)

Psyllium husk

10-20 g, total per day, minimum 8 weeks (2)(18) 

• Improvement in stool consistency and pain on defecation was observed when given 5 grams per day for 8 weeks when given 5 grams twice per day for 8 weeks (2)  
• Meta-analysis found psyllium to be effective in increasing stool frequency (22) 
• Supplementation for 12 weeks (10 g total per day) decreased constipation in patients with type 2 diabetes (18) 
• Psyllium given in addition to docusate sodium improved stool composition compared to docusate sodium alone, as demonstrated by increased stool water content, increased total stool output, and increased frequency of bowel movements (3.5 BM/week in psyllium, 2.9 BM/week in docusate), in patients with chronic idiopathic constipation (13) 
• Chronically constipated adults experienced improved MRI-measured descending colonic chyme, fasting colonic volume, and mean postprandial small bowel water when supplemented with 7 g of psyllium three times per day (9)

Address hard stool with the evidence-based ingredients in this protocol. 

Senna

8.6 mg total per day, as needed (20)

• When compared with lubiprostone, senna capsules were found to have similar efficacy in alleviating opioid induced constipation as demonstrated by an improvement in patient assessment of constipation (PAC)-symptoms (PAC-SYM) and the PAC-quality of life (PAC-QOL) score; the only difference found between groups was for completeness of bowel movement in which lubiprostone was favored, and reduction of abdominal pain in which senna being favored (10)
• Senna was more effective for fecal continence and constipation when compared with polyethylene glycol in children with corrected anorectal malformations (24)
• When given in addition to docusate, 8.6 mg of senna improved time to first bowel movement; additionally, only 7.0% of patients requested magnesium citrate to initiate a bowel movement compared to 43.6% in placebo with docusate (20)

Magnesium

400-800 mg magnesium oxide for 1-2 weeks (variable based on form and body weight) (15)(21)

• When given 800 mg of magnesium oxide, overall incidence of constipation decreased as well as atrial fibrillation, nausea and vomiting, in patients undergoing cardiac bypass surgery compared to control (15)
• Intestinal transit improved as shown by increased duodenal-cecal transit time, fecal fat, fecal weight, postprandial gallbladder relaxation, peptide YY release, and delayed fasting recurrence of phase II and affected antroduodenal motility when given oral magnesium sulphate with a meal compared to placebo (21)
• 57.5% of children given magnesium oxide (125 mg of magnesium oxide three times per day for children less than 20 kg or 250 mg three times per day for those weighing more than 20 kg) achieved good response of 3 or more bowel movements per week compared to 68.2% of children taking cisapride (0.2mg/kg) after 1 week of therapy (17)