Do Antibiotics Cause Constipation?
Diarrhea is the commonly thought of and more likely side effect of antibiotics. It actually occurs pretty often – to roughly 1 in 5 people. Diarrhea as a side effect of taking antibiotics even has an official name – antibiotic-associated diarrhea.
However, constipation can also be a side effect. If you began an antibiotic and then you developed constipation, the introduction of the antibiotic was likely the cause.
Antibiotics are effective and necessary to treat certain bacterial infections. They work by killing or starving the bacteria responsible for the infection.
As antibiotics work to kill pathogenic bacteria, they will also deplete the body of beneficial bacteria.
Decreasing good bacteria sets the stage for dysbiosis (an imbalance of good and bad bacteria) (4). This imbalance is the reason constipation or diarrhea develops.
Not surprisingly, with each round of antibiotics, the more likely (and potentially more severe) a case of dysbiosis can become. In other words, the likelihood and severity of digestive problems can increase with each round of antibiotics.
Today we’re talking about different types of antibiotics, how they cause constipation, other causes of constipation, and our best recommendations for solving chronic constipation.
What is Constipation?
According to Johns Hopkins Medicine, 4 million people in the US have frequent constipation – this is a very common digestive concern (13)!
Although people use the term constipation regularly, you might not actually know the definition. Constipation occurs when you have one or more of the following:
- Less than 3 bowel movements per week
- Incomplete emptying
- Hard, dry, or pellet-like stool that is difficult to get out
Being constipated will also have other negative impacts such as bloating and abdominal pain.
When constipation is ongoing (lasting three or more months), other symptoms that may develop include:
- Gallstones
- Nausea
- Heartburn
- Headaches
Why is constipation so uncomfortable and problematic? Elimination is the final phase of detoxification in the body (if this concept is new to you, click here to learn about how we are designed to eliminate toxins and natural ways to support detoxification ). If the body isn’t able to get rid of what it doesn’t need, things like toxins and bile will remain in circulation.
What Causes Constipation?
Constipation is typically classified as primary (having no obvious cause) or secondary (having an identifiable cause).
Medications
- Opioids – Vicodin, OxyContin, Percocet, Codeine, Morphine
- NSAIDS – Aspirin, Ibuprofen, Aleve, Celebrex
- Calcium channel blockers – used to treat high blood pressure, such as Amlodipine or Procardia
- Antacids – Alka-Seltzer, Tums, Mylanta, Rolaids, Pepto-Bismol
- Antihistamines – Zyrtec, Benadryl, Allegra, Clairitin
- Diuretics – used to treat high blood pressure or edema such as spironolactone or lasix
- Chronic laxative use
Supplements
- Iron
- Not taking the right probiotics for your needs – read more about that here.
- Prebiotics – such as inulin or FOS
Other Causes of Constipation
- Hypothyroid – make sure to read our blog post on this topic – even if you’ve been told your thyroid is “normal.”
- Diabetes
- Multiple Sclerosis
- Parkinson’s disease
- SIBO
- Dysbiosis
- IBD
- Intestinal strictures
- Pelvic floor dysfunction
Side Effects of Antibiotics
Beyond constipation and diarrhea, dysbiosis caused by antibiotics can contribute to the development of many chronic diseases, such as:
- Diabetes
- Obesity
- Asthma
- Rheumatoid arthritis
- Depression
- Autism
- Irritable bowel disease (7)
- C.diff (a severe infection causing diarrhea)
- Rash, hives, and other skin irritation
- Digestive issues like stomach pain, nausea, and loose stools
- Dizziness
- Yeast infections
Children who are prescribed prolonged courses of antibiotics, born via c-section, or formula fed are more likely to develop chronic constipation later in life due to the impact of these things on the microbiome (5, 6).
You should immediately contact your doctor if you develop more severe side effects caused by an allergic reaction, including difficulty breathing, coughing, wheezing, shortness of breath, or swelling.
How to Reverse Side Effects of Antibiotics
Unfortunately, even just one round of antibiotics can impact the microbiome for a very long time.
Research shows that it can take the microbiome anywhere from four weeks to four years to recover from a single round of antibiotics. (8, 9, 10, 11)!
Our assumption would be that the impact would be on the shorter end of that timeframe for someone who hasn’t taken antibiotics often and follows a clean diet (stays close to the food chain, consuming lots of fruits, vegetables, probiotic food sources, proteins, and healthy fats), manages stress well and is diligent with probiotics…a history of breastfeeding and vaginal birth also help!
Most people can’t claim such a clean bill of health, though. Processed foods, formula feeding, C-section births, stress, and exposure to multiple rounds of antibiotics would increase the time it takes to replenish the microbiome and eliminate symptoms caused by antibiotics.
Tips for recovering from antibiotics:
If you resonate with the last paragraph in the section above – you’re with most of us! Here are some things that you can do to recover well from antibiotics faster:
- Be selective when taking an antibiotic – ensure it’s necessary and the infection is bacterial. Always defer to your doctor (we are all for good conventional medicine), but don’t hesitate to speak up or ask for alternative ideas if you aren’t comfortable taking antibiotics. Your doctor works for you and should be open to working with you regarding your health.
- Increase the variety of plants you include in your diet. Participants in this study who ate more than 30 plants each week had a more diverse microbiome AND less antibiotic resistance (12).
- Take a probiotic supplement.
- Be sure to take your probiotic supplement 1-2 hours away from taking your antibiotic so that it can work effectively.
- We also recommend continuing to take your probiotic supplement for several months after you finish the course of antibiotics.
- Eat a daily serving of fermented food – here are some ideas:
- Make your own salad dressing with 2 Tbsp of sauerkraut juice mixed with olive oil
- Top your burger with kimchi
- Add kefir to a muffin recipe instead of milk
- Eat yogurt with your cereal or granola
- Add fermented beets and cabbage as a salad topping
- Eat prebiotic foods daily, which are food for good (probiotic) bacteria:
- Add onions and garlic to an omelet
- Roast asparagus as a side dish or add to a stir fry
- Use green bananas in a smoothie
- Make a dairy-free spinach artichoke dip
The Overuse of Antibiotics
Around 47 million unnecessary antibiotic prescriptions are written annually in the United States (1)!
At least 28% of antibiotics prescribed in an outpatient setting are unnecessary, meaning no antibiotic was needed (2).
Even the CDC says, “Too many antibiotics are prescribed unnecessarily and misused, which threatens the usefulness of these important drugs…Unnecessary use also happens when a person is prescribed antibiotics for infections sometimes caused by bacteria that do not always need antibiotics, like many sinus and some ear infections.”
The CDC has even developed a program called Be Antibiotic Aware, designed to reduce the overprescribing of antibiotics and combat antibiotic resistance.
Antibiotics should not be prescribed for viruses like the flu or the common cold. They also aren’t always necessary for sinus infections, bronchitis, or even ear infections, even though those are caused by bacteria.
Types of Antibiotics
Different categories of antibiotics are prescribed to treat different types of bacterial infections.
It’s beyond the scope of this post to review the different antibiotics, but it’s important to differentiate between a few:
- Broad-spectrum antibiotics – can treat a range of infections but aren’t selective in what types of bacteria they kill. Examples include Augmentin and Ciprofloxacin. These antibiotics are more commonly associated with constipation, especially when used frequently or for a long duration.
- Non-absorbable antibiotics stay locally in the digestive tract and are used in treatment protocols for IBS-C caused by SIBO (3). Examples include Rifaximin and Neomycin.
Constipation Relief
If you suffer from constipation, you’re likely familiar with these common conventional treatments:
- Osmotic laxatives such as Miralax
- Stimulant laxatives such as Dulcolax or Senna
- Stool softeners
- Enemas
Overusing laxatives or enemas can cause dependence. If you’re looking for more natural ways to support the body (so you aren’t always relying on help to poop), read on!
How to Empty Your Bowels
First and foremost, you want to address the root cause of your constipation. If the cause of your constipation is a medication, we recommend discussing this with your doctor.
If you’re concerned an antibiotic may be responsible for your constipation or other GI problems – here’s an interesting debate:
- Most doctors recommend completing the prescribed round rather than stopping early because this can cause antibiotic resistance.
- However, some scientists and doctors argue that you should discontinue the antibiotic once your symptoms are gone (reducing the time you are on the medication, which could reduce the amount of damage done to the microbiome). We aren’t here to take sides but find the argument interesting!
Here are our preferred labs to run when getting to the root cause of constipation for our clients:
Below are some simple and natural things you can do to get things moving. 💩
Foods for Constipation
- Two kiwis daily (14)
- Prunes first thing in the morning (soak 2-3 in water or stew at least 10 minutes before consuming)
- Electrolyte-rich foods (tomatoes, avocado, cantaloupe, carrot/celery/tomato juices, cucumber, or citrus fruits)
- Increase healthy fat intake – ensure you have a good source of fat at every meal. Fat lubricates the digestive tract. Good sources to add to your diet include ghee, butter, olive oil, coconut-based products, avocado, and egg yolks.
- Coconut oil prune puree
Drinks That Make You Poop
- Warm water with lemon juice or mineral water in the morning – chewing this rather than just swallowing – yes, we said to chew your water! 😉 (15)
- Add MCT oil to water or coffee – start with 1 tsp and work up as tolerated.
- Look at your urine color to assess if you are well hydrated. It should stay a very pale yellow color throughout the day.
- Prune juice – start slow (we usually recommend 4 ounces first thing in the morning) and wait….if you don’t get the result you were hoping for, try another two ounces around lunchtime. Prune juice can cause diarrhea if you do too much too fast, so go low and slow here (16).
Supplements for Constipation
Like the prune juice word of caution in the section above, we recommend a slow workup with supplements for constipation. Constipation isn’t fun, and neither is diarrhea.
We recommend trying the supplements below one at a time rather than adding several quickly. You can also find this protocol in our Fullscript dispensary.
Nutrients
- Magnesium Citrate – up to 1000mg daily
- Vitamin C – start at 1000mg and work up as tolerated – caution: this dose is not recommended for people with kidney stones or prone to kidney stones
- Fiber
Digestive Support
- Prokinetics (see ginger extract in our dispensary) – read more about prokinetics below.
- Digestive enzymes or bitters
- Betaine HCl – caution: this should not be used if you are on a proton pump inhibitor
- Cellcore Bowel Mover– contains herbs like aloe vera, ginger, and fennel that promote the natural movement of the intestines.
- How to order: register a customer account with CellCore; you’ll need to use the patient direct code rNTD3V7I to create your account.
Probiotics (18, 19)
Natural Prokinetics
Prokinetic literally means pro: “supporting or for” + kinetic: “motion.”
The digestive tract moves food along when its muscles contract and relax, creating a wave-like motion called peristalsis. Prokinetic agents promote the natural movement of the digestive tract by making contractions larger or more frequent.
If constipation is due to slow transit, meaning your system is taking longer than what’s considered normal to move food through, a prokinetic supplement or prescription can help speed up your transit time.
If you have chronic constipation and have never tried a prokinetic, consider talking to your doctor about the prescription Motegrity or trying a natural prokinetic like ginger.
There are many other prokinetics, but diving into the pros and cons of all of them is beyond the scope of this post. This is where working with an experienced healthcare practitioner is helpful!
Other Tips for Constipation Relief at Home
- Use a squatty potty to get in the correct position to poop (20)
- Movement/Exercise (21)
- Try little movement breaks if you’re sitting all day or not used to having an exercise routine. Moving your body for a few minutes could look like walking to your mailbox, taking the stairs several times, or jumping jacks between meetings.
- Pelvic floor therapy or biofeedback therapy to retrain the muscles involved in pooping (22)
Conclusion
Constipation can occur when taking antibiotics and, because of their impact on the microbiome, can continue long after you finish it.
Fortunately, there are things you can do to replenish your good gut bacteria (i.e. eat a varied diet, take a probiotic supplement, eat fermented foods and prebiotic rich foods) and get you pooping!
If you need individualized support, start working with one of our registered dietitians to find the root cause of your constipation and fix it!
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