Psyllium (Plantago ovata) husk can be used to treat constipation. And, the popular fiber supplement Metamucil® is 100% psyllium fiber, attesting to the effectiveness of this treatment. There is a lot of research demonstrating that psyllium can help with constipation, but it can even help chronically constipated people as well.
The reason this herbal remedy works is still somewhat illusive, but has to do with it being a bulk laxative and maybe also because it changes the bacteria in the gut. The changes in gut bacteria can lead to short chain fatty acids being created, which might help with constipation.(source 6)
Possibly the most important thing to be aware of when you are using psyllium is that you need to get plenty of fluids when you take it! If you don’t drink enough liquid, you could become even more constipated as a result. So make sure to drink plenty of water as well.
Psyllium may take some time to fully improve your symptoms, and treatments with this herb usually last for long periods of time. So if you are looking for more of an emergency measure to have a bowel movement quickly, consider a strong herbal laxative like aloe vera latex or cascara sagrada.
But, if you are looking for a natural way to treat constipation, you may want to try a different approach than psyllium.
Research shows that prunes and flaxseed are individually more effective than psyllium at relieving constipation.(source 10)(source 11) So, combining these two natural remedies and eating them at the same time might even produce a synergistic healing result!
There are a lot of herbal remedies for constipation, and Herbsey has a lot of information on these different approaches.
How to take Psyllium for Constipation
A 2018 study in Complementary Therapies in Medicine(source 2) stated the exact way that psyllium husk helps treat constipation was currently not fully understood. Yet it is understood that it is a viscous, gel forming fiber supplement and is a bulk fiber laxative.
A systematic review of studies on fiber supplementation for chronic constipation was published in 2022 in The American Journal of Clinical Nutrition.(source 1) The review included 16 studies with a combined total of 1,251 participants.
The review states that doses of 10 g / day for at least 4 weeks appears to be the optimal treatment protocol for constipation. Although, the study does say that there were considerable differences between the studies it reviewed.
Side Effects of Psyllium & Dosage Guidelines
Although we already discussed taking in plenty of water and other fluids as a key thing to remember about using psyllium (as not doing this can cause pretty bad constipation), there are some other concerns.
This topic is outside the scope of this article, but Herbsey does have an entire evidence-based overview of the side effects and dosage guidelines for this herb. If you have time, check out the link below to get the facts on how to be safe when using psyllium.
Side Effects of Psyllium & Dosage Guidelines
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Why Psyllium Works as a Laxative
A 1995 study in Alimentary Pharmacology & Therapeutics(source 3) suggested that the beneficial effects of psyllium for constipation are mainly related to helping the defecation process. The constipation relieving effects are not associated with changes in colonic or rectal motor function.
A StatPearls paper(source 4) on the U.S. National Library of Medicine website states that psyllium is a bulk laxative; and, describes how bulk laxatives work:
These agents retain fluid in the stool and increase stool weight and consistency. Psyllium, dietary fiber, and methylcellulose are common examples. It is important to take ample amounts of water for bulk-forming agents to work. Lack of water, in turn, leads to bloating and can cause bowel obstruction.
Laxatives. StatPearls Publishing LLC (2023)
Although clearly the reason why psyllium works is of course due to it being a bulk forming laxative, there may be a microbiological reason as well.
A 2019 study in the International Journal of Molecular Sciences(source 5) looked at how psyllium would influence constipation and gut bacteria. The study used both constipated and healthy volunteers.
Psyllium supplementation had a small, but statistically significant effect, on gut microbial composition of healthy adults. In constipated participants the gut microbial composition change was greater. The study found several microbes to be associated with alterations in gastrointestinal transit, short chain fatty acids, and stool water content in constipated participants.
A 2023 study in Gut Microbes(source 6) looked at how psyllium husk influenced gut bacteria in 250 constipated adults. The study used psyllium in two different treatment approaches; one being psyllium, and the other being psyllium plus wheat bran. Oligosaccharide (a carbohydrate whose molecules are made from a small number of monosaccharides) supplementation was also used with these treatments as well.
The study showed that gut Anaerostipes (an anaerobic bacterial genus) constantly increased in both groups of people taking psyllium husk. This increasing trend tended to be associated with a higher bowel movement frequency.
The study cites research where Anaerostipes was able to convert dietary inositol (a sugar made in the body and found in foods) into acetate and propionate. Acetate and propionate are both short chain fatty acids (SCFAs). SCFAs are metabolites which are synthesized when bacteria ferment specific prebiotic fibers in the colon.
SCFAs are relevant to constipation because they may acidify intestinal pH, inhibit pathogens, help with colonic motility, and improve bowel movement frequency.
The study suggested that this may help to explain the possible way in which dietary fiber helps relieve constipation via optimizing gut microbes like Anaerostipes.
The study has this to say about dietary fiber supplementation and how it helps remedy constipation:
Collectively, dietary fiber supplementation, may substantially relieve constipation, by interactions with host gut microbes, and modulations of microbe abundance in functional constipation patients; host gut microbiota may predispose the ways of their interactions with fiber intake, resulting in the individual differences in constipation symptom improvement.
Gut Microbes [15.1 (2023): 2197837]
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Chronic Constipation & Psyllium Treatment
A 2021 study in the Official Journal of the American College of Gastroenterology(source 7) looked at 79 patients with chronic constipation (CC) with an average age of 42.7 years. These patients were randomly assigned to receive one of three treatments: psyllium, kiwifruit, and prunes. The patients took their respective treatments for 4 weeks.
The primary outcome the study measured was complete spontaneous bowel movements (CSBMs); and, the patients all had three or less CSBMs per week. The study found that the treatments all produced a similar rate of improvement in CSBMs.
When comparing symptoms on weeks 3 and 4 to the symptoms at the start of the study, the study found:
- Straining improved with all three treatments
- Stool consistency improved with prunes and kiwifruit
- Patients taking kiwifruit reported an improvement in bloating
- Side effects were most common with psyllium and least common with kiwifruit
A 2020 study in the Journal of the American Association of Nurse Practitioners(source 8) conducted a comprehensive review of studies in a 50 year time frame from 1968 to 2018.
The review found that psyllium was 3.4 times more effective at treating CC than insoluble wheat bran in terms of stool output.
The review also found that both psyllium and coarse wheat bran increased stool softening, stool water content. But, the finely ground wheat brand had a stool hardening effect of lowering stool water content.
The study concluded that it was a misconception to say that all dietary fibers provide a laxative effect for people with CC. So it is important to understand which types of fiber actually provide a benefit.
A 2021 study in Aging(source 9) looked at 54 women of reproductive age with CC. The women took either a placebo or psyllium husk with warm water two times a day for 4 weeks.
The study found that the psyllium husk treatment relieved the symptoms of constipation in the women. And, it also showed that the composition of the gut bacteria of these women was changed. The bacteria’s metabolism was also changed by the treatment; and, the researchers speculated this might be related to the changes in symptoms.
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Psyllium VS Other Natural Constipation Remedies
An interesting study published in 2019 in Clinical Nutrition ESPEN(source 10) compared psyllium and flaxseed in the treatment of constipation. The participants in the study were 77 constipated people with type 2 diabetes.
The participants took 10 g of either flaxseed, psyllium, or placebo twice a day for 12 weeks. Constipation symptoms and other metrics were monitored at the beginning and at various intervals through the duration of the experiment.
The patients were graded on a scale of points: -3 markedly worse, -2 somewhat worse, -1 a little bit worse, 0 no change, +1 a little better, +2 somewhat better, and +3 markedly better.
The study found that flaxseed appeared to be superior for treating constipation than psyllium. People who took flaxseed reported an average improvement of 2.46 points. Those taking psyllium reported an improvement of 1.42 points.
The study came to the following conclusion: Although both flaxseed and psyllium may decrease constipation symptoms, weight, glycemic and lipid levels, treatment with flaxseed appear to be superior to psyllium.
A 2011 study in Alimentary Pharmacology & Therapeutics(source 11) compared prunes to psyllium to find out how effective they were at treating constipation. The study enrolled 40 participants who had constipation for 3 or more days a month for the past 3 months.
Participants took either 50 g of prunes twice a day with meals or 11 g of psyllium (Metamucil®) with 8 oz of water twice a day for a 3 week period.
The study’s main measure was complete spontaneous bowel movements per week was improved with the use of both treatments. Stool consistency improved more with prunes than it did with psyllium. But, overall constipation symptoms did not differ between the psyllium and prune groups, showing that the treatments were similar.
The study concluded that prunes were superior to psyllium in treating constipation, stating: Dried plums are safe, palatable and more effective than psyllium for the treatment of mild to moderate constipation, and should be considered as a first line therapy.
The conclusion of this matter seems to be that it would be better to combine flaxseed and prunes in the diet with plenty of water to arrive at a better therapy for constipation than just relying on psyllium husk.
Herbsey has an entire evidence-based article on using flaxseed for constipation, feel free to check it out if you have time.
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About the Author
Geoff Kent is a natural medicine enthusiast who has been researching and writing about natural medicine since 2008. Geoff is primarily a web developer, but also researches and authors written and video content about natural health. Geoff has a bachelor’s degree in Management Information Systems from the University of Northern Iowa.
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