Probiotics with laxatives improve functional constipation in children, Study Finds

Pediatric constipation is highly prevalent in Taiwan and ranges from 0.7 to 29.6% across different countries. Functional constipation is seen in about 95% of the pediatric population. However, the effect of pharmacotherapy is limited. The noted success rate is only 60%. Previous research has shown the benefits of probiotic supplements in treating this condition. There was uncertainty due to the varied strains of probiotics used in the study. Hence, Taiwanese researchers conducted a network meta-analysis to compare the efficacy and acceptability of different probiotic supplements for pediatric functional constipation.

A frequentist model-based network meta-analysis (NMA) was carried out by including RCTs of probiotic supplements for functional constipation in children. Potentially eligible articles without any language restrictions were included in the study. PICO design was implemented and based on this clinical RCT with waiting lists, placebo or active controls were considered. Children less than 18 years of age with functional constipation were included. The efficacy of probiotics on stool frequency and bowel movements was investigated.

The objective outcome of bowel movement or stool frequency defined as the number of bowel movements/stool passages per fixed period was considered as the outcome of the study. STATA version 16.0 was used for NMA.

Findings:

• Nine RCTs were included with about 710 participants having a mean age of 5.5 years. There were 49.4% girls.
• A significant improvement in bowel movement or stool frequency was seen by using the probiotic products either alone or combined with laxatives than placebo or control.
• The greatest improvement in bowel movement or stool frequency among all the investigated probiotic products was seen with Protexin plus laxatives.
• Lactobacillus casei rhamnosus Lcr35 was the only probiotic associated with significant efficacy in single probiotic interventions, compared to placebo/control treatments.
• The fecal incontinence and patient drop-out rates were similar among the investigated probiotic products to those of placebo/control treatments.

Thus, the study concluded that most of the probiotics combined with laxatives have a better outcome for constipation. They produced significantly better improvement in bowel movement/stool frequency. Hence, researchers underscored the importance of using an advanced combination of probiotics and laxatives for pediatric functional constipation if there is no concurrent contraindication.

Further reading: Yang, WC., Zeng, BS., Liang, CS. et al. Efficacy and acceptability of different probiotic products plus laxatives for pediatric functional constipation: a network meta-analysis of randomized controlled trials. Eur J Pediatr 183, 3531–3541 (2024). https://doi.org/10.1007/s00431-024-05568-6.