Exploring the potential of probiotic interventions for a common pediatric condition through scientific research and clinical trials
Imagine your child struggling with a problem that affects their daily life, causes physical pain, and creates emotional distress—yet effective solutions are limited and often come with unpleasant side effects.
of children in western countries affected by functional constipation 1
of children experience adverse effects from traditional laxatives 1
percentage of children cured after six months of laxative treatment 1
This is the reality for millions of families worldwide dealing with childhood functional constipation. For these children, constipation isn't just an occasional inconvenience but a chronic condition characterized by infrequent painful defecation, fecal incontinence, and abdominal pain that causes "distress to child and family and results in severe emotional disturbance and family discord" 1 .
The traditional treatments—polyethylene glycol and lactulose—while effective at increasing defecation frequency, come with a troubling downside. These side effects often lead to low compliance, which in turn results in a low percentage of children being cured after six months of laxative treatment. This frustrating reality has motivated scientists to explore alternative approaches, including probiotic interventions that might offer relief with fewer side effects. Among the most promising candidates is a specific bacterial strain: Bifidobacterium lactis DN-173 010.
To understand why probiotics might help with constipation, we first need to explore the complex ecosystem within our digestive tracts. The human gut hosts trillions of microorganisms—bacteria, viruses, and fungi—collectively known as the gut microbiome. This community performs essential functions including breaking down food, extracting nutrients, and protecting against pathogens.
When the microbial community falls out of balance, various digestive problems can occur, including constipation 5 .
The bidirectional communication between the gut and brain influences digestive function and overall well-being.
Research suggests that constipated individuals may have a different composition of gut bacteria compared to those with normal digestion. This discovery led scientists to investigate whether supplementing with specific beneficial bacteria might restore balance and improve bowel function. The theory is that certain probiotic strains can influence colonic peristalsis (the wave-like muscle contractions that move waste through the colon), primarily by producing organic acids like lactic and acetic acid through their metabolic activities 1 .
These acids lower the pH in the colon, which subsequently enhances peristalsis and decreases colonic transit time—the duration it takes for food to travel through the digestive system—both of which are beneficial for relieving constipation 1 .
Among the thousands of bacterial strains inhabiting the human gut, one specific probiotic has attracted significant scientific attention for its potential role in managing constipation: Bifidobacterium lactis DN-173 010. This particular strain is a key component of fermented dairy products, including certain commercial yogurts, and has been studied extensively for its effects on digestive health.
Previous research in adults had demonstrated that Bifidobacterium lactis DN-173 010 could significantly decrease transit time in both young and elderly healthy adults 1 . Additionally, studies involving adults with constipation-predominant irritable bowel syndrome (IBS-C) and constipated women showed that consumption of fermented milk containing this probiotic strain led to a significant increase in stool frequency, particularly in those with a defecation frequency of less than three times per week 1 .
These promising results in adults, combined with a small pilot study in Dutch children that showed normalization of defecation frequency in five of eight constipated children 1 , provided the foundation for a more comprehensive investigation in pediatric populations.
A specific probiotic strain studied for its effects on digestive health and potential benefits for constipation.
To rigorously test whether Bifidobacterium lactis DN-173 010 could help children with constipation, researchers designed a sophisticated randomized, double-blind, controlled trial—considered the gold standard in clinical research 1 2 . This approach minimizes bias and provides the most reliable evidence about a treatment's effectiveness.
The study, published in the journal Pediatrics in 2011, was conducted across multiple medical centers in the Netherlands and Poland, enrolling 159 constipated children who met specific diagnostic criteria for functional constipation 2 .
To participate, children had to be between 3-16 years old and have a defecation frequency of less than three times per week, along with at least one additional symptom such as fecal incontinence, painful defecation, or withholding behavior 1 .
The study methodology was meticulously planned with several key components:
This rigorous methodology allowed researchers to isolate the specific effect of Bifidobacterium lactis DN-173 010 from other factors that might influence constipation, providing clear evidence about its potential benefits.
After three weeks of product consumption, the results revealed important insights into the potential role of probiotics in managing childhood constipation. While both groups showed improvement—highlighting the benefit of structured toilet training and regular defecation attempts—the specific effect of the probiotic strain yielded unexpected findings.
The data showed that the change in stool frequency from baseline increased in both groups, but the difference between them was not statistically significant 2 .
| Group | Change in Stool Frequency (bowel movements/week) | Statistical Significance |
|---|---|---|
| Probiotic Group (Bifidobacterium lactis DN-173 010) | 2.9 ± 3.2 | P = 0.35 |
| Control Group (Non-fermented dairy product) | 2.6 ± 2.6 | Reference |
Beyond stool frequency, researchers examined several secondary endpoints that contribute to a comprehensive understanding of constipation management.
| Endpoint | Probiotic Group | Control Group |
|---|---|---|
| Stool Consistency | Improved | Improved |
| Frequency of Fecal Incontinence | Decreased | Decreased |
| Pain During Defecation | Reduced | Reduced |
| Abdominal Pain and Flatulence | Similar reduction | Similar reduction |
| Adverse Effects | No serious adverse events | No serious adverse events |
| Aspect | Probiotic Approach | Traditional Laxatives |
|---|---|---|
| Side Effects | No serious adverse events reported 2 | 30-50% experience adverse effects 1 |
| Common Side Effects | Minimal | Abdominal pain, bloating, flatulence, diarrhea, nausea 1 |
| Taste Acceptance | Generally well-accepted | Often bad taste reported 1 |
| Compliance | Likely higher due to fewer side effects | Frequently low due to side effects 1 |
From a safety perspective, an important finding was that no serious adverse events were reported in either group 2 . This safety profile is significant given the high rate of side effects associated with traditional laxative treatments for childhood constipation.
The findings from this study present a nuanced picture of probiotics for childhood constipation. On one hand, the specific strain Bifidobacterium lactis DN-173 010 did not demonstrate a statistically significant advantage over the control product in increasing stool frequency 2 . This led the researchers to conclude that there was "not sufficient evidence to recommend fermented dairy products containing B lactis strain DN-173 010 in this category of patients" based on their study alone 2 .
However, looking at the broader context of probiotic research provides a more optimistic perspective. A 2023 comprehensive review of multiple studies concluded that probiotic intake in children with functional constipation significantly improved treatment success rate and defecation frequency, while also decreasing the constipation recurrence rate 5 .
The effectiveness of probiotics appears to depend on multiple factors including the specific bacterial strain, dosage, treatment duration, and the characteristics of the patient population.
Why the discrepancy? The 2023 review noted that the positive effects of probiotics on stool frequency were particularly significant in Asian populations 5 , suggesting that genetic, dietary, or environmental factors might influence how individuals respond to probiotic interventions.
Additionally, the researchers behind the Bifidobacterium lactis DN-173 010 trial suggested that future studies should "focus on whether a longer period of probiotic products is more effective in children who have a short history of constipation" 2 . This highlights the possibility that the three-week intervention period might have been insufficient to manifest the full benefits of the probiotic approach, particularly for children with long-standing constipation.
Conducting rigorous research on probiotics requires specific tools and methodologies. Below is a table outlining key components of the research toolkit used in studying Bifidobacterium lactis DN-173 010 for childhood constipation:
| Research Tool | Function and Importance |
|---|---|
| Bifidobacterium lactis DN-173 010 | The specific probiotic strain under investigation, carefully characterized and standardized for research purposes 1 . |
| Fermented Dairy Product (Activia®) | The delivery vehicle for the probiotic strain, ensuring adequate dosage and viability of the bacteria 1 . |
| Control Product (Milk-based non-fermented dairy) | A visually identical product without probiotics, essential for comparing the specific effect of the probiotic against a placebo 1 . |
| Standardized Bowel Diary | A tool for participants to systematically record defecation frequency, stool consistency, and associated symptoms, providing objective outcome measures 1 . |
| Rome III Criteria | Standardized diagnostic criteria for functional constipation, ensuring consistent participant selection across research centers 1 . |
| Bisacodyl Rescue Medication | A standardized laxative available to all participants if needed, ensuring ethical treatment while monitoring additional medication use as a study outcome 1 . |
While the specific study on Bifidobacterium lactis DN-173 010 in children with constipation didn't show superior results compared to the control product, it represents an important piece in the larger puzzle of developing effective, well-tolerated treatments for childhood constipation. The absence of serious adverse effects is itself a significant finding, particularly when compared to the high rate of side effects associated with conventional laxatives 1 2 .
For now, parents of children with constipation should consult with healthcare providers about a comprehensive approach that may include dietary modifications, proper toilet training, and potentially probiotic supplementation, while recognizing that a multifaceted strategy is typically most effective for managing this complex condition.
The search for better treatments continues, but the investigation of probiotics like Bifidobacterium lactis DN-173 010 represents a promising direction that may ultimately lead to more comfortable solutions for children struggling with constipation. The journey of scientific discovery rarely follows a straight path. While any single study might not provide definitive answers, each contribution advances our understanding and moves us closer to better solutions for challenging health conditions like childhood constipation.