Irritable Bowel Syndrome, Gut Motility, and Probiotics

By Jun Kim Ph.D.


It was previously discussed [IBS, Sibo, Probiotics] that one of the investigated observations in irritable bowel syndrome (IBS) involves small intestinal bacterial overgrowth (SIBO). Another common parameter that is used to characterize pathophysiology of IBS is alterations in gut motility. Gut motility is the stretching and contractions of the muscles in the gastrointestinal (GI) tract, and it controls the movement of food throughout the digestive tract. The synchronized contraction of these muscles is called peristalsis. Abnormal motility pattern can lead to bloating, pain, nausea, diarrhea, and constipation, all of which are symptoms related to IBS.

Gut motility can be characterized by the migrating motor complex (MMC), which is a distinct pattern of electromechanical activity observed in gastrointestinal smooth muscle. During MMCs, there is periodic, luminal contractions that push intestinal contents from the stomach to the last part of the small intestine, ileum. Several studies have shown that IBS patients can have abnormal MMC. For example, Vassallo et al. showed that IBS patients had stronger and longer contractions more frequently, which reflects the increased perception of pain [1]. Another study showed that patients with diarrhea-predominant IBS had accelerated transit of intestinal contents to the colon [2].

Changes in gut motility can be divided into three categories based on the symptoms of IBS: (i) diarrhea-type, (ii) constipation-type, and (iii) pain-type [3]. In diarrhea-type, it has been noted that there are increased contractions after food ingestion, increased propagating contractions, decreased intestinal transit time, and rapid evacuation of intestinal contents [4–6]. In constipation-type, decreased propagating contractions of the colon, longer transit time, and rapid evacuation have been shown [5–8]. In pain-type, contractions have been shown to be more concentrated in jejunum and ileus with significantly larger propagating contractions during abdominal pain and anorectal sensitivity disorder [9–12].

Multiple studies suggest the importance of gut microbiota in gut motility. Bifidobacterium and Lactobacillus were less abundant in adult patients with constipation [13,14]. However, other studies showed an increased abundance of Bifidobacterium or abundance changes in other species [15,16]. Such contrasting outcomes suggest that the association between gut motility and gut microbiota may depend on the patient demographics and is species specific. Furthermore, it is important to note that the alterations in gut microbiota can be either a cause or a result of the conditions. For example, when mice with human gut microbiota were induced to have faster intestinal content transit using different methods, they had similar changes in gut microbiota composition, suggesting that changes in GI transit can affect the composition of the microbial community [17].

Studies that associate gut motility and gut microbiota may suggest that taking probiotics influence gut motility. Indeed, studies have shown that taking probiotics such as Bifidobacterium animalis and Bifidobacterium lactiscan accelerate intestinal transit and improve symptoms in constipation-type patients [18–20]. However, the outcomes seemed to depend on the probiotic species as some probiotics have shown to decrease bowel movements, and improve loose stool in diarrhea-type patients [21,22]. Species-dependent response was demonstrated in a study where intestinal bacteria promoted or suppressed MMC in rat model depending on the species [23]. Although currently not available, a systematic comparison of the species-specific effect of probiotics on gut motility is needed for more consistent results. It would be very interesting to see whether a certain combination of probiotic species can both increase and decrease bowel movements depending on conditions and be effective for all three categories of the symptoms.

Disclaimer: The above article is sponsored by Thyrve, the world’s first Gut Health Program that incorporates microbiome testing and personalized probiotics to ensure a healthier gut, happier life, and a brighter future. 


[1] Vassallo MJ, Camilleri M, Phillips SF, Steadman CJ, Talley NJ, Hanson RB, Haddad AC: Colonic tone and motility in patients with irritable bowel syndrome. Mayo Clin Proc 1992, 67:725–731.

[2] Horikawa Y, Mieno H, Inoue M, Kajiyama G: Gastrointestinal motility in patients with irritable bowel syndrome studied by using radiopaque markers. Scandinavian Journal of Gastroenterology 1999, 34:1190–1195.

[3] Mantides A: Gut motility and visceral perception in IBS patients. Annals of Gastroenterology 2002, 15:240–247.

[4] Vassallo M, Camilleri M, Phillips SF, Brown ML, Chapman NJ, Thomforde GM: Transit through the Proximal Colon Influences Stool Weight in the Irritable-Bowel-Syndrome. Gastroenterology 1992, 102:102–108.

[5] Bazzocchi G, Ellis J, Villanueva-Meyer J, Reddy SN, Mena I, Snape WJ, Jr.: Effect of eating on colonic motility and transit in patients with functional diarrhea. Simultaneous scintigraphic and manometric evaluations. Gastroenterology 1991, 101:1298–1306.

[6] Cann PA, Read NW, Brown C, Hobson N, Holdsworth CD: Irritable bowel syndrome: relationship of disorders in the transit of a single solid meal to symptom patterns. Gut 1983, 24:405–411.

[7] Bazzocchi G, Ellis J, Villanuevameyer J, Jing J, Reddy SN, Mena I, Snape WJ: Postprandial Colonic Transit and Motor-Activity in Chronic Constipation. Gastroenterology 1990, 98:686–693.

[8] Stivland T, Camilleri M, Vassallo M, Proano M, Rath D, Brown M, Thomforde G, Pemberton J, Phillips S: Scintigraphic Measurement of Regional Gut Transit in Idiopathic Constipation. Gastroenterology 1991, 101:107–115.

[9] Prior A, Maxton DG, Whorwell PJ: Anorectal manometry in irritable bowel syndrome: differences between diarrhoea and constipation predominant subjects. Gut 1990, 31:458–462.

[10] Kellow JE, Phillips SF: Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology 1987, 92:1885–1893.

[11] Gorard DA, Libby GW, Farthing MJ: Ambulatory small intestinal motility in ‘diarrhoea’ predominant irritable bowel syndrome. Gut 1994, 35:203–210.

[12] Schmidt T, Hackelsberger N, Widmer R, Meisel C, Pfeiffer A, Kaess H: Ambulatory 24-hour jejunal motility in diarrhea-predominant irritable bowel syndrome. Scand J Gastroenterol 1996, 31:581–589.

[13] Khalif IL, Quigley EM, Konovitch EA, Maximova ID: Alterations in the colonic flora and intestinal permeability and evidence of immune activation in chronic constipation. Dig Liver Dis 2005, 37:838–849.

[14] Chassard C, Dapoigny M, Scott KP, Crouzet L, Del’homme C, Marquet P, Martin JC, Pickering G, Ardid D, Eschalier A, et al.: Functional dysbiosis within the gut microbiota of patients with constipated-irritable bowel syndrome. Alimentary Pharmacology & Therapeutics 2012, 35:828–838.

[15] Zoppi G, Cinquetti M, Luciano A, Benini A, Muner A, Minelli EB: The intestinal ecosystem in chronic functional constipation. Acta Paediatrica 1998, 87:836–841.

[16] Zhu LX, Liu WS, Alkhouri R, Baker RD, Bard JE, Quigley EM, Baker SS: Structural changes in the gut microbiome of constipated patients. Physiological Genomics 2014, 46:679–686.

[17] Kashyap PC, Marcobal A, Ursell LK, Larauche M, Duboc H, Earle KA, Sonnenburg ED, Ferreyra JA, Higginbottom SK, Million M, et al.: Complex interactions among diet, gastrointestinal transit, and gut microbiota in humanized mice. Gastroenterology 2013, 144:967–977.

[18] Marteau P, Cuillerier E, Meance S, Gerhardt MF, Myara A, Bouvier M, Bouley C, Tondu F, Bommelaer G, Grimaud JC: Bifidobacterium animalis strain DN-173 010 shortens the colonic transit time in healthy women: a double-blind, randomized, controlled study. Aliment Pharmacol Ther 2002, 16:587–593.

[19] Waller PA, Gopal PK, Leyer GJ, Ouwehand AC, Reifer C, Stewart ME, Miller LE: Dose-response effect of Bifidobacterium lactis HN019 on whole gut transit time and functional gastrointestinal symptoms in adults. Scand J Gastroenterol 2011, 46:1057–1064.

[20] Miller LE, Ouwehand AC: Probiotic supplementation decreases intestinal transit time: meta-analysis of randomized controlled trials. World J Gastroenterol 2013, 19:4718–4725.

[21] Ki Cha B, Mun Jung S, Hwan Choi C, Song ID, Woong Lee H, Joon Kim H, Hyuk J, Kyung Chang S, Kim K, Chung WS, et al.: The effect of a multispecies probiotic mixture on the symptoms and fecal microbiota in diarrhea-dominant irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial. J Clin Gastroenterol 2012, 46:220–227.

[22] Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’Mahony L, Kiely B, Shanahan F, Quigley EM: Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol 2006, 101:1581–1590.

[23] Husebye E, Hellstrom PM, Sundler F, Chen J, Midtvedt T: Influence of microbial species on small intestinal myoelectric activity and transit in germ-free rats. Am J Physiol Gastrointest Liver Physiol 2001, 280:G368–380.