If you’ve been told to take a prokinetic after SIBO treatment – or you’ve read about them online – you might be wondering what they actually do. This post explains how prokinetics work, how they’re different from laxatives, and whether they’re worth taking if you’re dealing with symptoms like bloating, reflux or nausea.
What is a prokinetic agent
The word means promoting (pro) and move (kinetic), so it’s about promoting movement.
Prokinetic supplements and medicines help amplify and coordinate the gastrointestinal muscular contractions to facilitate the transit of the contents of your digestive tract.
This means they are useful to encourage the movement of food through the upper part of the gut, and also the migrating motor complex (MMC).
This means prokinetic agents can do two things for helping manage your SIBO:
- Stimulate and co-ordinate the passage of foods through the intestine, though influencing the nervous system to increase the smooth muscle contractions.
- May decrease transit time but they aren’t meant to cause a bowel movement like a laxative would (see below for more on that aspect).
Prokinetics can work on the upper GI tract, or the whole digestive system. These agents are particularly helpful for symptoms where motility isn’t effective and things are either moving back upwards, or stagnating.
You could be experiencing upward movement of air (frequent burping), nausea or acid reflux (where stomach acid burns the oesophagus). Prokinetics may be helpful for promoting stomach emptying and upper gastrointestinal symptoms.
You can also use prokinetic agents for symptoms like:
- Feeling very full / Stomach not emptying quickly
- Bloating
- Gas
- Constipation
Prokinetics aren’t the same as laxatives
If you’re someone with IBS-D or frequent loose stools you might be worrying that a prokinetic would make things worse. Many of my client ask me this!
As I mentioned above, prokinetic agents shouldn’t be confused with laxatives. The differences are as follows:
- Laxatives should cause a bowel movement either through increasing bulk, bringing water into the gut, or stimulating the large intestine to evacuate.
- Laxatives don’t stimulate the migrating motor complex (you can read more about the internal house keeper which keeps your gut clean – the migrating motor complex)
- Prokinetics won’t stimulate a bowel movement, and can be used with people who have IBS-D.
The way they work is by acting on neurotransmitters that control our gut motility.
Medical agents affecting motility include Domperidone (often used for sickness), Prucalopride, Naltrexone, or Erythromycin. These last two are taken at a very low dose to create the prokinetic effect.
Herbal prokinetic supplements
Herbal prokinetic include ginger which has a long history of traditional use for nausea and sickness. Ginger is also an antioxidant anti-inflammatory agent which can support immune health which might also help in SIBO.
You also can try taking ginger to help you consume more food if nausea and fullness are preventing you from eating a a proper sized meal. This can be helpful if you’re worried about unintentional weight loss.
When should you take a prokinetic for SIBO?
Firstly, it’s important to note that prokinetic agents are only part of the solution for SIBO. You also need to work on diet, eating habits, and lifestyle changes such as sleep, exercise and stress management. Supplements alone won’t fix the problem.
Lasting relief from SIBO symptoms usually needs a combination of diet, supplements and lifestyle changes like improving sleep and reducing stress.
There are two cases when a prokinetic might be helpful
- As soon as you’ve finished your round of antibiotic or antimicrobial supplements to address the SIBO the prokinetic could help to stimulate the MMC. This could help slow down the SIBO relapse (and unfortunately you might well relapse after a round of treatment). Taking the prokinetic before bed is best to help the overnight fast enable the MMC process.
- To improve symptoms such as nausea, feelings of fullness and belching. You can take the prokinetic alongside your treatment for SIBO such as the antimicrobial herbal supplements.
How long should you take a prokinetic agent for?
Prokinetics can be taken for a few months at a time. Some people will take them for longer. You can test reducing your dose gradually, perhaps only taking it on alternate days as you feel better, or after around 3 months. Just notice if any symptoms return. Then you can slowly reduce your prokinetic to every 3-4 days, and so on.
If you do feel symptoms are coming back you can revert back to your full dose to see if you can stop the SIBO returning. You could also add in some antimicrobial treatment at this time to knock the bacteria on the head and prevent another relapse of the SIBO.
Are there any risks of taking prokinetics?
You may experience some side effects such as
- Diarrhoea
- Bloating – this is because foods are being moved through the gut quicker, and if it’s not getting enough time to digest it could impair digestion causing bloating.
- Pain – stimulation of smooth muscles in your digestive tract which might irritate your visceral hypersensitivity.
- Acid reflux – particularly at the start of taking a prokinetic, if you’re very constipated you might feel
- Ginger burn – you might feel better drinking more water with your ginger supplements to help wash it down.
Taking a prokinetic agent may not prevent your SIBO relapsing. However, it may extend the amount of time you have in between treatment rounds. This means there is more time for working on your lifestyle habits such as changing the way you eat and exercise, stress management, sleep routines etc.
Need more help with SIBO supplements?
I recorded a podcast about the best supplements for SIBO, Episode 31 of the Inside Knowledge for people with IBS. You can read the transcript here, or listen wherever you get your podcasts.
As a SIBO Nutritionist I help people work out what to eat, how to eat and lifestyle changes to help get relief from symptoms. If you’re unsure which supplements are right for your SIBO symptoms – or how to combine them with the right diet – I can help.
I work with people over three months (minimum) and you can read more about my Gut Reset programme here. You can email me about setting up a discovery call, or use the form on my Contact page.
IBS Nutritionist
Hi, I'm Anna Mapson, registered Nutritional Therapist.
I help people with IBS and SIBO get control of unpredictable gut symptoms to find long term relief from painful and embarrassing IBS without restrictive dieting.
I can help you to:
- understand your digestion better, so you recognise your triggers
- eat a well balanced diet, with tasty meals that are simple to prepare
- reintroduce your trigger foods so you can get back to enjoying food again
Find more about my 3 month 1:1 Gut Reset programme.
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Very helpful article. Anna does a great job of explaining SIBO and ways to manage it.
Thank you Susan. Have you found any specific ways of managing SIBO that really work for you?
Very informative. And well explained as science behind the nutrition
Very good I suffer with incompetence Spencer n motility , and gastritis I’m on treatment and diet
I have sibo with diarrhea. I have dysautonomia, fibromyalgia, small fiber neuropathy, sjogren’s, hashimoto’s thyroiditis and
Microscopic colitis
How can I contact you for my gut issues
Hi Ena You can contact me via my Contact page to book time in my diary and have a conversation about what you need help with – or email info@goodnessme-nutrition.com
I have taken Canxida, oregano, digestive enzymes, allium, and lots of other things. I do not want to take an antibiotic. I still have stomach problems. Now, I am going to try a prokinetic. Is this a good idea? I try to stay on a Sibo diet or Candida diet, but it is hard.
Would Sibo cause me to have equilibrium problems?
Thank you!
Hi Sandy, SIBO can be really hard to get rid of, I wonder if you’ve identified the root cause, i.e. what was causing you to get SIBO in the first place. Sometimes taking the antimicrobials isn’t effective if you’re still not eating enough food, have obstructions, or a low functioning MMC for example. One of the main problems I see with a long term SIBO diet is you get reduced large intestine bacteria, which can also cause issues. Have you tried reintroducing foods back in to see if you can expand your diet at all? I really hope you get some progress soon, it’s awful going round in circles. If you want to talk about working with me 1:1 just feel free to book some time for a free call so we can see what might be needed. All the best 🙂
Good Day,
Are your services extended outside of the U S. I’m in Bermuda and have been struggling with Sibo, IBS C and leaky gut for years. I did the low fodmap diet, cut out gluten, dairy, nuts, soy, eggs and corn for years. I took the medication two weeks ago but still have no relief. If you are able to assist, I would welcome any advice.
Thank you!
Hi,are ginger supplements more effective than ginger tea for imo sibo
Hi Michael Yes, supplements will be stronger, because they are concentrated. So around 1g of ginger in capsule form will be hard to replicate in tea or raw ginger.
Would you recommend an elemental diet? Between the foods I’m reacting to and the sibo diet restrictions there is little left that I can eat. My symptoms are getting better but it would be nice if the elemental diet would maybe help the healing process.
Hi Kristy
Whether to go on an elemental diet is definitely a conversation to have with a doctor, so best ask them whether it would be suitable for you. I know it’s very challenging to consume only liquid for 2-3 weeks with no eating, people do struggle with this. If you’d like to talk through the SIBO diet restrictions you mention I might be able to help you work out how to eat more variety. Let me know if you’d like to speak to me about SIBO. 🙂
Hi Anna, I’m still having bloating issue for a year already. Doctor didn’t want to test me for SIBO or IBS, he gave me PPI which didn’t work for my symptoms. Now he prescribed domperidone. I don’t have issue with nausea or vomitting, just epigastric discomfort up to my chest when feeling so bloated. Do you think it’s safe to take domperidone daily? I read that it could cause arrhytmia.
Hi Mika I can’t comment on whether or not to take medication as I’m not a doctor, so this would be something to discuss with them. If you’d like to work on your diet and digestion I’d be happy to have a chat about how to manage symptoms through changes to your eating, food and lifestyle. You can make an appointment to speak to me about working together if you’re interested
Hi, I have been suffering from methane dominated SIBO for over a year now, have tried refexamine twice then Metronidazole. Nothing seems to be working. I am on a SIBO diet as well. My doctor say there’s nothing they can do for me. I am taking oregano, garlic and Berberine caps. At night I take Ginger caps along with Magnesium
Nothing is working. Can you suggest something pls. I live in UK.
i have battled sibo over four years. i am currently taking flagyl and rifaxamin. how soon can I retest and how soon should I start taking a prokinetic? Thank you?
You can retest as soon as you’ve finished the treatment round but most people find they can’t access or afford another test so soon.
Thank you Anna for so much help offered freely.
I was found positive for SIBO and completed course of antibiotics, GP would not fund them. £250 but worth it. Which brands would you recommend for anti kinetic supplements? Thank you, Nic
Hi Nic, If I’m not working with someone unfortunately I can’t recommend supplements including brands and doses sorry. If you’d like to get personalised recommendations then I’d love to speak to you about working together in the 3 month Gut Reset. Please set up a call to tell me more about what you need help with www.calendly.com/annamapson/30min
I have a question about this. I was given Motegrity after I finished my first round of Xifaxan. I have continued on it as I have an abnormality in my small bowel from a prior surgery so my doctor wanted me to stay on it to see if this would help with motility long term. I have had additional rounds of Xifaxan and was not told to discontinue the Motegrity during those rounds. I am wondering why it is suggested to take after the antibiotics are finished and if there is a problem to take them while on a prokinetic?
Thanks for any info!
Hi there, I have a question about the prokinetic. I have been on 2mg of Motegrity for about 6 weeks. I started it after my first round of Xifaxan. I have subsequently had 2 more rounds of Xifaxan but have continued to take the Motegrity while on the antibiotic. Is that not recommended and if so , why not? I also had been taking the Motegrity before bed as that is what Pimentals book recommended as well. But I was having inconsistent results so wondered if I should try it in the morning instead? I will definitely look into your work with me tab as you seem wonderful and like you really want to help. This is just a very frustrating condition:/