Probiotics and Their Role in Alleviating IBS and Constipation in Children 

Irritable Bowel Syndrome (IBS) and constipation are common gastrointestinal issues that can significantly impact the well-being of children. Treatment options for irritable bowel syndrome (IBS) are notoriously inadequate or come with potentially serious side effects and risks.¹ It’s crucial to explore gentle, holistic approaches (that actually work) to address these concerns. Probiotics have the potential to modulate the gut microbiota and have emerged as a promising solution. In this article, we’ll delve into the relationship between probiotics, IBS, and constipation in children, examining specific probiotic strains, prebiotics, and their mechanisms of action. 

Understanding IBS and Constipation in Children 

IBS is a functional gastrointestinal disorder characterized by abdominal pain, discomfort, and altered bowel habits. Constipation, a frequent symptom of IBS, can lead to further complications if not managed effectively. Having fewer than 3 bowel movements a week is considered constipation, but best case scenario is having one well formed, easy to pass stool a day. 

Children experiencing constipation may encounter challenges in daily life that affects their overall quality of life. The discomfort of constipation can be debilitating and lead children to fear certain foods and become anxious about their bowel habits. 

Constipation is very common in children and there are many reasons why a child might suffer from irregularity. Inadequate fiber, excess sugar, dehydration, medications, and stress/anxiety are the most common causes of constipation in children. Improving their diet by boosting fiber and water intake, creating a calm environment, and making sure they have plenty of time (especially in the morning) to have a regular bowel movement can make a big difference. 

Probiotics: A Holistic Approach 

Probiotics are living microorganisms that have health benefits when consumed in adequate amounts. The gut microbiota plays a crucial role in digestive health, and an imbalance can contribute to IBS and constipation. Probiotics work by restoring and maintaining a healthy balance of “good” gut bacteria, improving the gut microbiome and positively influencing various physiological processes. 

Probiotics can be taken as a supplement or consumed in food. I prefer my patients regularly eat probiotic foods and supplement with targeted probiotics only when necessary. 

Common probiotic foods include: 

• Yogurt
  
• Sauerkraut
  
• Kimchi
  
• Fermented vegetables
  
• Miso
  
• Kefir
  
• Tempeh
  

Most probiotic rich foods contain the bacteria strain Lactobacillus acidophilus. This bacteria is naturally present in the human intestines and is commonly added to dairy products like yogurt. Lactobacillus acidophilus is known for its ability to produce lactic acid, which helps create an environment in the gut that is conducive to the growth of beneficial bacteria. 

Although lactobacillus is the most common, there are many probiotic strains and different foods contain different combinations of them. Other commonly found probiotic strains in commercially-prepared foods include Bifidobacterium bifidum, Lactobacillus casei, Lactobacillus rhamnosus, and Streptococcus thermophilus. 

How do probiotics work? 

The mechanism of action of probiotics in improving symptoms of Irritable Bowel Syndrome (IBS) with constipation (IBS-C) is multifaceted and involves several aspects of gut physiology and microbiota interactions. While the exact mechanisms are still under investigation, research suggests that probiotics can improve IBS-C symptoms through various means:

1. Modulation of Gut Microbiota: Probiotics can alter the composition and function of the gut microbiota, increasing the abundance of beneficial bacteria and decreasing the presence of pathogenic bacteria. This balance is crucial for maintaining gut health and can influence bowel movement regularity and ease constipation.
2. Enhancement of Intestinal Barrier Function: Probiotics can strengthen the gut barrier, reducing intestinal permeability (often referred to as “leaky gut”). A stronger intestinal barrier can prevent the translocation of harmful bacteria and their toxins, reducing inflammation and its associated symptoms, including abdominal pain and discomfort associated with IBS. Probiotics appear to improve improve the tight junction of intestinal cells by regulating the expression of certain genes involved in cell signaling.²
3. Immunomodulation: Probiotics can modulate the immune response in the gut, promoting a more balanced immune environment. This can reduce the inflammation often seen in IBS patients, potentially alleviating symptoms of pain and discomfort.³
4. Influence on Gut Motility: Some probiotic strains can help regulate gut motility, which can alleviate constipation by promoting more regular bowel movements. They may affect the enteric nervous system, which controls gut movement, thus improving symptoms of IBS-C.⁴
5. Production of Short-Chain Fatty Acids (SCFAs): Probiotics can ferment dietary fibers to produce SCFAs, such as butyrate, propionate, and acetate. SCFAs directly feed the cells of the colon. Additionally SCFAs regulate gut pH and promote bowel movements, which can not only help alleviate constipation but provide intestinal healing.⁶
6. Antimicrobial Activities: Some probiotics produce substances that have antimicrobial properties, which can inhibit the growth of pathogenic bacteria in the gut, contributing to a healthier gut environment.⁷
7. Neuroendocrine Effects: Probiotics can influence the gut-brain axis, the communication network that links the emotional and cognitive centers of the brain with peripheral intestinal functions. This can potentially affect gastrointestinal symptoms like pain and bowel habit through the modulation of stress responses and pain perception. This article called Stress & the gut-brain axis provides an excellent summary.⁸

Efficacious Probiotic Strains 

Studies on children are often limited for obvious reasons. Probiotics are even more challenging to study because it can take weeks, and sometimes months, for their effects to be felt. Although there is some controversy around the need for probiotics in children suffering from constipation, there is some evidence that they may be helpful, especially in children with IBS. 

The most notable probiotics strains that have demonstrated clinical efficacy for children with IBS and constipation include: 

Lactobacillus species 

Lactobacillus is one of the most widely researched strains of probiotics, likely because lactobacillus species are responsible for the majority of fermentation found in human foods. This includes foods like yogurt, fermented vegetables like kimchi, sauerkraut, and pickles, and fermented meats like sausages and salamis. It can also be used for sourdough bread, certain cheeses, fermented fish and more. Research indicates that Lactobacillus reuteri and Lactobacillus rhamnosus GG are the species with the best evidence for helping children with gastrointestinal issues. Lactobacillus reuteri in particular has significant evidence showing efficacy for infant colic, also increasing bowel movement frequency. This study in the Journal of Pediatrics showed that infants receiving L. reuteri had significantly increased frequency of bowel movements compared to the placebo group.¹⁰ It should be noted that Lactobacillus reuteri also has significant research for prevention of colic, including large population-based studies that show evidence of improving constipation in infants.¹¹

Lactobacillus rhamnosus GG shows promise for children with functional gastrointestinal issues, including milk protein allergy, irritable bowel syndrome¹² and diarrhea. However the studies on Lactobacillus rhamnosus are mixed, with one study showing that Lactobacillus rhamnosus is as effective as magnesium oxide (a commonly used laxative), and another showing it is ineffective compared to lactulose (another commonly used laxative). ^{13, 14}

Bifidobacterium species 

Bifidobacterium is another commonly researched strain of probiotics that has been found to improve stool frequency in children and adults. Its effects are similar to those of lactobacilli in that it increases short 

chain fatty acids and promotes peristalsis, supporting regular bowel movements. This strain is also effective in reducing abdominal pain and improving bowel habits in children with functional gastrointestinal disorders. 

Bifidobacterium lactis BB-12 is a specific probiotic strain that has been found to have positive health effects, including survival through the gastrointestinal tract, support for a healthy gut microbiota, improved bowel function, protection against diarrhea, and reduced antibiotic treatment side effects.¹⁵ In clinical trials, children who took BB-12 had significantly more bowel movements per week without causing loose stools.  BB-12 is particularly noteworthy since it has positive effects on immune function, improving resistance to respiratory infections and reducing the incidence of acute respiratory tract infections. BB-12 has well-established probiotic characteristics and demonstrates health benefits for the GI tract, immune health and managing constipation in children.¹⁵ 

Bifidobacterium breve M-16V may help improve constipation by softening stool consistency in children. In one small clinical trial, children who took M-16V for 12 weeks had softer stools than the control group.¹⁶ 

Bacillus species

Bacillus coagulans Unique-IS2 is a strain that has also been shown to reduce occasional constipation in children.¹⁷ In one randomized control trial, it was found to significantly reduce pain intensity, improve stool consistency, reduce abdominal pain, bloating, gas, straining, urgency and incomplete evacuation after just eight weeks of treatment6. This study demonstrated the efficacy of this particular strain in reducing the symptoms of IBS in children between the ages of 4 and 12 years old.¹⁷ 

Probiotic Blends 

One of the most extensively studied probiotic blends is VSL#3, a combination of eight different strains of bacteria, including various species of Lactobacillus, Bifidobacterium, and Streptococcus. A study published in the “Journal of Pediatric Gastroenterology and Nutrition” found that VSL#3 significantly improves abdominal distension, abdominal pain and flatulence in pediatric patients with Irritable Bowel Syndrome. However there were no statistically significant differences in stooling patterns.¹⁸

In one large meta-analysis and systematic review, researchers found that probiotic intake in general significantly improved the treatment success rate, stool frequency, and reduced the risk of constipation in children9. However, they did not find any clear associations between probiotics and other IBS symptoms like abdominal pain, stool consistency, or pain while having a bowel movement.¹⁹ This review analyzed many types of probiotics and found that the variability in strain, dosages and study durations in the research highlights the need for more clinical studies to draw clear conclusions on probiotics in children struggling with constipation.¹⁹ 

Prebiotics: Nourishing the Gut Microbiome 

Prebiotics are non-digestible food components that promote the growth and activity of beneficial microorganisms, such as bacteria and fungi, in the gut. Unlike probiotics, which are live beneficial bacteria, prebiotics serve as food for these microorganisms, helping to improve the balance and composition of the gut microbiota. Prebiotics are found naturally in a variety of foods and can also be isolated or synthesized and added to foods and supplements.

Common prebiotic compounds include inulin, fructooligosaccharides (FOS), galactooligosaccharides (GOS), and resistant starch. These compounds are found in a wide range of foods, including:

• Bananas
  
• Garlic
  
• Onions
  
• Jerusalem artichokes
  
• Asparagus
  
• Apples
  
• Oats
  
• Flaxseeds
• Legumes

There is a significant amount of research into the role of prebiotics in the treatment of pediatric constipation as well, but this is beyond the scope of this article. It should be noted that some children with dysbiosis (altered gastrointestinal microbiome or microbiome with pathogenic flora) will worsen with prebiotics rather than improve. Use caution when treating IBS patients with prebiotics.

Conclusion:

Probiotics, along with prebiotics, offer a natural approach to addressing IBS and constipation in children. Although the research remains rather limited, there is some evidence that specific strains offer specific benefits. To recap, Lactobacilli and bifidobacterium are well-researched and effective strains for children with IBS. BB-12, M-16V, and B. coagulans Unique-IS2 show promising effects for constipation and S. boulardii is a better option for diarrhea.

Although probiotics can be a powerful tool for providing relief from symptoms and improving overall digestive health, it’s important to remember the basics! Aim to keep sugar intake to a minimum, include fiber rich foods at every meal, and drink plenty of water to optimize gut health.
Remember, it’s always important to consult with your provider before you begin a new supplement routine. If you’d like to increase your pre and probiotic intake, food is a great place to start. If you need more support, consider working with your provider to incorporate specific pre and probiotics into a comprehensive treatment plan tailored to your child’s needs.

References:

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