Gut motility
Gut motility
Medically reviewed by:
Dr John Freeman
Gut motility is one of the most important—but often overlooked—factors in Small Intestinal Bacterial Overgrowth (SIBO). Addressing impaired motility can significantly reduce the risk of recurrence and, in many cases, may have been a contributing factor to SIBO developing in the first place.
What is gut motility?
Think of your digestive tract as a complex pipeline. For good gut health, contents need to move forward, efficiently, and at the right pace.
In a healthy digestive system, food moves steadily through the stomach and small intestine. It is only once contents reach the large intestine that movement naturally slows. This slowing allows water to be absorbed and stools to form properly.
For people with SIBO, slow movement through the small intestine is problematic. When food sits there too long, bacteria have extra time to ferment it—leading to bloating, pain, and the risk of bacterial overgrowth returning.
This is why addressing gut motility after treatment with antibiotics or evidence-based herbal antimicrobials is a critical step in preventing relapse.
Why gut motility matters in SIBO
The small intestine is meant to contain very small numbers of bacteria. When motility is impaired and food lingers, bacteria do what they naturally do best: metabolise food and multiply.
This process may:
Trigger SIBO initially
Cause symptoms to return shortly after treatment
Undermine otherwise effective therapy
Once food reaches the large intestine, slower movement is normal and beneficial. Here, remaining nutrients are processed, water is absorbed, and stool is formed.
Key mechanisms that control gut motility
Several coordinated processes keep food moving efficiently through the digestive tract.
1. Peristalsis
Peristalsis is the wave-like contraction of smooth muscle that pushes food forward after eating. Muscles behind the food bolus contract, while muscles in front relax, allowing contents to move onward. This process is regulated by specialised pacemaker cells called interstitial cells of Cajal (ICCs).[1]
2. Segmentation
Segmentation mixes food with digestive enzymes and fluids, breaking it down into smaller particles. While segmentation does not move food forward, it makes contents easier for peristalsis to transport.
An easy way to picture this: large bricks are difficult to push, but small pebbles move with far less effort. Segmentation turns “bricks” into “pebbles.”[2]
3. The Migrating Motor Complex (MMC)
The MMC is often described as the house cleaner of the small intestine. It occurs during fasting states—typically when you haven’t eaten for 90–120 minutes—and sweeps residual food particles and excess bacteria out of the small intestine.
This process is facilitated by motilin, a hormone produced in the small intestine. A well-functioning MMC is essential for long-term gut health and SIBO prevention.[3]
People with SIBO should not underestimate the importance of the MMC. Without it, bacteria are more likely to accumulate and overgrow.
Factors that impair gut motility
Gut motility can be disrupted by many conditions and lifestyle factors, including:
Gastroparesis
Oesophageal motility disorders
Chronic stress
Nicotine use
Certain medications
These factors may coexist with SIBO or contribute to repeated recurrence if left unaddressed.
Treating gut motility issues: available options
Just as SIBO sufferers have options between drugs and natural supplements to kill off the small intestinal bacterial overgrowth, they have those options with gut motility issues.
Caution:
Your doctor will know what’s right for you, and you should always consult them. This information has been provided to give you insight into how these drugs work and why they are often used to treat and manage gut motility issues.
Treating gut motility issues with drugs
Drugs used to treat gut motility are called a prokinetic agent (sometimes referred to as gastroprokinetic agent, gastrokinetic agent or propulsive).
Some of the most common drugs used to address gut motility are:
Metoclopramide (Maxolon)
Domperidone (Motilium)
Other agents include:
Prucalopride
Mosapride
Tegaserod
Itopride
Renzapride
Linaclotide
How do gut motility drugs work?
Prokinetic agent drugs work by enhancing gut motility. They do this by increasing the strength or frequency of contractions we spoke about earlier without disrupting the rhythm.
Prokinetic agent drugs work by enhancing gut motility. They do this by increasing the strength or frequency of the earlier contractions without disrupting the rhythm.
They may be beneficial for SIBO sufferers with slow gut motility as a root cause.
They can assist food in moving through the small intestine. Your doctor may prescribe these if you have frequent reoccurrences and clear signs of slowed gut motility.
Conditions prokinetics are commonly used for:
These drugs are often used to treat the following gastrointestinal issues that many SIBO sufferers experience:
Bloating
Constipation
Heart burn
Nausea and/or vomiting
They are also used to treat other gastrointestinal disorders such as:
“IBS” (of which we know a large % is attributed to SIBO)
Gastritis
Gastroparesis
Functional dyspepsia
Natural and herbal support for gut motility
Unlike with drugs (which are heavily regulated), when evaluating supplements, we must make sure the ingredients, herb or product is supported by scientific evidence to improve gut motility.
When selected appropriately, certain herbs have demonstrated measurable prokinetic effects.
Globe artichoke (Cynara scolymus)
Globe artichoke supports gut motility by:
Increasing bile flow
Improving digestion and segmentation
Providing mild antispasmodic effects that help relax intestinal muscles
It has also been shown to have hepatoprotective and cholesterol-lowering properties.
In formulations, globe artichoke is often paired with ginger. Artichoke appears to act primarily on small intestinal motility, while ginger acts more strongly on the stomach.[4]
For individuals with SIBO, improved bile flow and faster transit through the small intestine means less time for bacteria to ferment food, which may help reduce recurrence risk.
Ginger (Zingiber officinale)
Ginger has a long history of use in digestive health and has been shown to:
Stimulate gastrointestinal motility
Accelerate gastric emptying
Modulate inflammation
Support circulation[5,6]
While ginger’s strongest effect is on stomach emptying, this can still be beneficial for people whose SIBO may be driven by delayed gastric transit.
Putting it all together
Gut motility is not just a supporting factor—it is often central to long-term SIBO management. Without restoring healthy movement through the small intestine, even the most effective antimicrobial treatment may offer only temporary relief.
This is why many post-treatment protocols, including structured programs such as the FixBIOME Gut Reset, place strong emphasis on restoring motility alongside microbial balance.
1 Kumral and Zfass
2 Kumral and Zfass
3 Kumral and Zfass
4 Giacosa et al.
5 Nikkhah Bodagh et al., “Ginger in Gastrointestinal Disorders: A Systematic Review of Clinical Trials”
6 Hu et al.
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