Probiotics for the intestines for constipation

Published: March 17, 2020 at 01:32 pm

More and more often, probiotics and prebiotics are used as part of complex therapy in the treatment of constipation. These are drugs and nutritional supplements that contain live bacteria that can restore intestinal microflora and suppress opportunistic microorganisms. Each medicine has its own chemical formula, it can consist of one type of bacteria or several colonies

.
Based on this, prescriptions are made for constipation, so it is very difficult to say unequivocally which one is better
.
It is important for the common man to know how probiotics and prebiotics differ from each other, and what bacteria can form the basis of food additives
. We'll talk about this in the article.

Prebiotics are most often prescribed to relieve constipation in adults and children. Unlike probiotics, they are based on biological structures that are not destroyed by gastric juice and are not absorbed in the small intestine; once they reach the large intestine, they create a favorable environment for the growth of beneficial microflora

.
You can speed up organ recovery during constipation by including fermented milk products, corn, beans, garlic or peas in your daily diet. Many food manufacturers produce drinks fortified with prebiotics, and their presence is always indicated on the label
.
In chronic forms of constipation, dietary adjustments do not help, so there is a need to take medications
.
They are sold in pharmacies in the form of tablets, powders, and active supplements
. Only an experienced doctor, gastroenterologist or proctologist can say which of them is better.

Which probiotics are best for constipation?

The story about which probiotics are best to drink for constipation in adults and children must begin with a description of the effect of such drugs. If prebiotics are dietary supplements that contain live bacteria (lactobacteria, bifidobacteria, combinations thereof) that help restore microflora, then probiotics are components that can stimulate the growth of microorganisms located inside the large intestine

. Do you feel the difference?

Inside the capsules there may be a food substrate, coarse fiber, which, entering the hollow organ, interacts with water, swells, pushes out stagnant feces, and with it toxins and wastes that interfere with the process of reproduction of beneficial microorganisms. This relieves constipation

.
Other probiotics help maintain a specific pH environment inside the hollow organ
. With it, the microflora feels good, and the opportunistic microflora slows down its development.

Considering the principle of action of the described medications, often when treating constipation in adults and children, many doctors first prescribe the use of probiotics, which help suppress the opportunistic environment, and then recommend drinking prebiotics. Their range is large; when choosing, the severity of the patient’s condition and his age are taken into account. So, for example, when it comes to treating a child, the best option is the use of Normobact, a drug that combines the effects of both probiotics and prebiotics

.
This symbiosis prolongs the life of positive bacteria, helps to increase their number, making it possible to reduce the treatment time for chronic constipation in children to ten days. Normobact for constipation is now prescribed to adults as well, if they are eliminated with the use of antibiotics
. Normobact is not a medicine, and this is taken into account when developing an effective therapy strategy.

Bacteria for constipation

When prescribing probiotics and prebiotics for constipation, their generation is taken into account:

The first generation of drugs contains one type of beneficial bacteria. Lactobacterin, for example, belongs to this group.
Second-generation prebiotics contain bacteria that do not live in the intestines of an adult. Synthetic components have been developed that can actively suppress the opportunistic environment. (Enterol, Sporobacterin).
The third generation of prebiotics can boast of containing several types of colonies (Linex, Acylact). These drugs are most often prescribed to adults and children.
The fourth generation - symbiotics - products that contain both prebiotics and probiotics. The above-mentioned Normobact is the best representative of the described class.
The latest fifth generation products are multicomponent tablets that contain different biological colonies.

When solving the dilemma of which beneficial bacteria to take for constipation, it is important to learn to distinguish between their groups.

Bifidobacteria suppress the growth of putrefactive microorganisms, promote rapid digestion of carbohydrates, and create a protective environment that prevents the penetration of pathogens and toxins into the blood and further into all internal organs. This is why probiotics are effective for constipation

.
Their components are involved in the utilization of food substrates, in the processes of formation of amino acids, proteins and vitamins, and increase the percentage of absorption of various chemical compounds necessary for the normal functioning of the body
. The intestinal microflora of infants consists of 90% of the described bacteria, therefore, in the treatment of constipation in infants, first-generation drugs are often prescribed.

Lactobacilli found in probiotics create an acidic environment in the intestine in which all opportunistic microorganisms die. At the same time, the described microorganisms are involved in strengthening local immunity, they help fight allergies, stimulate intestinal contractility, therefore medications containing lactobacilli are often used for constipation

. There are also probiotics on sale, which contain Escherichia coli, bacilli, Saccharomycetes and Enterococci. They can also be useful in the fight against the indicated ailment.

Disturbances in the functioning of the digestive organs and problems with the regularity of bowel movements cause a lot of problems, which are not accepted to be discussed openly. Constipation is one of the most common complaints when visiting a gastroenterologist and the reason for searching for an effective self-medication at the pharmacy

.
Chronic bowel retention, not associated with surgery, a long trip, or stress, is a serious problem
. In addition to radical methods of resolving the situation, such as rinsing and taking a laxative, which occasionally have to be resorted to, probiotics give good results for constipation in adults.

How probiotics make bowel movements easier

People often do not realize that the cause of rapid fatigue, relapses of bacterial and viral infections, and various vitamin deficiencies is constipation, provoked by the death of the intestinal biocenosis. These pathological conditions must be eliminated as quickly as possible, otherwise health problems will only accumulate and worsen. Probiotics can help relieve constipation in adults and children from difficulties with bowel movements.

These preparations contain dried cultures of living beneficial microorganisms that are in anaerobic “hibernation”. Bacterial strains exhibit their therapeutic activity in the liquid biological environment of the human body. After penetrating the stomach, beneficial fungi and bacteria enter the intestines, where the most favorable conditions for their growth and reproduction are present.

This is interesting: In the course of their life, microorganisms break down polysaccharides, inulins, and fiber into products that create an environment with acidic pH values.

A course of probiotics has a complex positive effect:

restoration of optimal intestinal microbiocenosis;
increasing the volume of feces due to beneficial bacteria;
elimination of excess gas formation, rotting and fermentation processes;
increased tone of intestinal smooth muscle muscles;
stimulation of the synthesis of folic acid and vitamin K, helping to improve blood circulation.

intestinal antiseptics;
enterosorbents;
antimicrobials;
balanced complexes of vitamins and microelements.

Taking probiotics creates an acidic environment in the intestines that is harmful to staphylococci, enterococci, and E. coli. Their numbers gradually decrease to optimal values - 15% of the total mass of bacteria.

Uses and functions of beneficial bacteria

The work of drugs to restore the processes of digestion and bowel movements is aimed at stimulating the growth of beneficial microorganisms in the large intestine.

Probiotics are bacteria and yeasts that are normally present in healthy human intestinal flora. They counteract pathogenic and opportunistic microorganisms
.
The weight of the inhabitants of the gastrointestinal tract of an adult is about 2-3 kg. They perform many useful functions in the digestive system, promote the production of folic acid, biotin, vitamin K, and resist toxic substances
.
Healthy digestion is the key to strong immunity
. Violations of the qualitative and quantitative composition of beneficial bacteria lead to various problems, one of which is stool retention.

Most probiotics used for constipation in adults contain lactobacteria (lat. Lactobacillus) or bifidobacteria (lat. Bifidobacterium) and perform the following functions:

restore normal microflora and pH;
stimulate the synthesis of epithelial cells of the gastrointestinal tract;
normalize water and electrolyte balance in the intestinal lumen;
help digest, absorb and move food through the intestines;
promote the production of digestive enzymes.

Probiotics can be dry or liquid, in the form of medicines, foods and dietary supplements. Dry ones are lyophilized microorganisms in the composition of tablets, powders, capsules, in which gelatin acts as a binder. After consumption, beneficial bacteria come out of anabiosis within 1-4 hours, i.e.

.
"sleeping state"
. Liquid is the original form of probiotics in a state of activity without lyophilization, their component composition:

Microorganisms in a physiologically active state.
Nutrient environment for bacteria.
Additional ingredients to enhance the effectiveness of the medicine (for example, amino acids, micro- and macroelements, water-soluble vitamins).
Metabolites are products of metabolism and vital activity of bacteria.

The advantage of liquid drugs is their immediate effect immediately after entering the body. Disadvantage - bifidobacteria and lactobacilli are not prescribed in cases of acute prolonged constipation, because they give noticeable results gradually, and treatment of an advanced disorder takes a long time (from 2 weeks to several months with repetitions of the course)

. Very few live bacteria reach the colon with suitable conditions for their proliferation.

Solving the problem of constipation, especially if it has become chronic, is not an easy task. First you need to find out the cause of your symptoms.

.
In addition to treating a specific disease, the patient is prescribed a special diet, light exercise, and sometimes laxatives are prescribed
. Thanks to an integrated approach, positive changes will not keep you waiting.

To use probiotics to improve digestion, normalize healthy intestinal microflora, and relieve constipation, it is advisable to first consult with your doctor.

Definition of probiotics

Probiotics are a range of medications that contain live bacteria that regulate the number of beneficial microorganisms that populate the microflora of different parts of the intestine.

Regular consumption of probiotics improves functioning throughout the entire digestive tract, helps strengthen the body’s immune forces, as well as the production of vitamins, folic acid, biotin, and also improves the absorption of nutrients.

Probiotics can be found in foods. A large number of beneficial bifidobacteria are found in fermented milk drinks: yogurt, sour cream, kefir.

The pharmaceutical industry creates drugs with ready-made probiotics. They are quite easy to use, begin to act almost immediately, and are well tolerated by the body.

Many patients, in search of a cure for irregular bowel movements, resort to various medications, which often do not have the desired effect.

They all want to find a medicine that will constantly work and make the act of bowel movement more pleasant. Most products give a one-time effect and problems with stool remain.

Only probiotics guarantee good relaxation of the intestines, and they can be consumed on an ongoing basis.

The choice of drug should be entrusted to a specialist. After all, individual intolerance to some medications may occur.

Are there any contraindications?

Like any other drugs, probiotics have their contraindications, most often associated with individual intolerance to the body. Usually bacteria are more easily accepted in dry form - tablets and capsules, but liquid ones are more effective. Allergic reactions may occur while taking the drug.

The most common side effects from taking probiotics include mild flatulence and bloating, which usually go away quickly. The presence of spore bacteria and yeast products in the composition increases the likelihood of intolerance, due to the content of not only spores in a state of suspended animation, but also strains that have toxic properties.

Some drugs may not be suitable for older people, and may not be combined with other medications and may reduce each other’s effectiveness. Appointment and reception should be carried out under the supervision of a specialist.

Probiotics are live microorganisms. Due to improper storage conditions, they die, become unsuitable for consumption, and do not provide results in the treatment of constipation.

When probiotics don't work?

Whatever healing properties preparations with live bacteria have, they are not always effective. The main reasons for the lack of the desired result:

an attempt to get rid of constipation as a symptom, without searching for the cause of this condition;
chronically occurring due to infection and disease;
disruption of the endocrine system;
unhealthy diet, fasting, diets;
consumption of large amounts of preservatives, flavor enhancers, dyes;
insufficient consumption of fermented milk products and fiber;
long-term use of antibiotics, laxatives, corticosteroids, oral contraceptives, drugs that impair secretory function;
too weakened immune system;
operations on the abdominal organs.

The listed factors create unsuitable conditions in the intestines for a long time for the life of beneficial bacteria, which will ultimately give a maximum of short-term improvements. Before taking probiotics, it is recommended to relieve exacerbation of chronic diseases, remove foci of infection, stabilize hormone levels, and improve nutrition.

In order for the body to work “like a clock,” the problem of constipation must be dealt with comprehensively. The proper functioning of the digestive system is a guarantee of your excellent health and longevity.

Doctors recommend improving digestion and regular bowel movements using medications that include strains of beneficial bacteria. Prebiotics and probiotics for constipation restore the intestinal microflora, destroying pathogenic microorganisms, accelerate the transit of food bolus, soften stool and facilitate the act of defecation.

The main cause of constipation

When a delicate problem arises with bowel movements, people rush to the pharmacy for laxatives or start eating prunes. Such methods will bring temporary relief, but will not eliminate the cause of the pathology. In addition, pharmaceutical and folk remedies cause addiction, dehydration and vitamin deficiency .

If constipation returns after stopping the medication, you should consult a doctor for a thorough diagnosis. There is a high probability that the body does not have enough beneficial bacteria that improve the functioning of the gastrointestinal tract.

A negative state develops:

with a monotonous diet;
during antibiotic therapy;
while following a strict diet;
after intoxication with endo- or exotoxins;
in the presence of chronic diseases of the digestive system.

The lack of beneficial bacteria provokes not only difficulties with bowel movements. Pathogenic microorganisms settle in the free space, which cause the formation of infectious foci in the internal organs.

So that a person does not suffer from symptoms of intoxication, and the gastrointestinal tract works like a clock, gastroenterologists recommend taking probiotics for constipation.

Benefits of probiotics and prebiotics

The intestines are inhabited by colonies of “bad” and “good” bacteria. Pathogens release toxins and poison the body

. Strains of living microorganisms improve intestinal function, kill harmful microbes, strengthen the immune system and eliminate constipation.

In a sick person, “bad” bacilli dominate over living bacteria. Such an imbalance leads to the development of dysbacteriosis, flatulence, diarrhea, as well as the appearance of belching, rumbling, constipation and other disorders of the digestive system

. Prebiotics and probiotics effectively eliminate gastrointestinal disorders.

The effect of prebiotics

Probiotics and prebiotics are bioactive substances with different mechanisms of action. They enhance each other's properties
.
Prebiotics reach the large intestine freely. Gastric juice is not able to destroy their structure
. They do not enter the blood from the small intestine.

Prebiotics form a favorable environment for the life and reproduction of living bacteria. Beneficial microorganisms that receive sufficient nutrients instantly increase the number of colonies and restore healthy microflora in the intestines.

They enter the body if a person eats cereals, flakes, legumes, corn, garlic, onions, and bananas. However, it is impossible to eliminate chronic constipation with food alone. To improve bowel movements, doctors prescribe tablets, capsules and powders, including prebiotics, to patients.

The preparations contain fiber, substrates, pectin - substances that can capture water and swell. Having increased significantly in volume, they, like a piston, squeeze out stagnant feces, wastes and toxins, which do not allow beneficial bacteria to reproduce. As a result, constipation disappears.

Impact of Probiotics

Probiotics are strains of “beneficial” bacteria. They need prebiotics to nourish, develop and reproduce.

. They improve the microflora and maintain it in a healthy state, while simultaneously suppressing the development of opportunistic microorganisms.

Their colonies are found in natural fermented milk products (yogurt, yoghurt, kefir, cheeses), drinks produced by the food industry, and sauerkraut. But the best effect in treating constipation is provided by drugs enriched with one type or several varieties of beneficial bacteria.

It is difficult for probiotics to reach the colon unchanged. When transporting them:

dissolves gastric juice;
destroys bile.

Sometimes these bioactive substances are rejected by the intestinal microflora and do not allow them to take root. They break down under the influence of antibiotics.

Preparations with bacterial strains are protected from exposure to aggressive environments. The tablets are coated with special coatings, and the capsules are made from stable substances

. The protective coatings disintegrate in the large intestine, and bacteria immediately find themselves in favorable conditions.

How to choose and take probiotics

Choosing the right probiotic is key to treating constipation, as some strains may not be as effective as others.

Look for supplements that contain the following strains of bacteria that have been shown to improve stool consistency (, , ):

Bifidobacterium lactis
Lactobacillus plantarum
Streptococcus thermophiles
Lactobacillus reuteri
Bifidobacterium longum

While there is no specific recommended dosage for probiotics, most supplements contain 1–10 billion colony-forming units (CFU) per serving ().

For best results, use them only as directed and consider reducing your dosage if you experience persistent side effects.

Given that supplements can take several weeks to work, stick with one specific type for 3-4 weeks to evaluate its effectiveness before switching to another.

Or try incorporating a variety of probiotic foods into your diet.

Fermented foods such as kimchi, kombucha, kefir, natto, tempeh, and sauerkraut are rich in beneficial bacteria as well as many other important nutrients.

Summary:
Some strains of probiotics may be more effective than others in treating constipation. In addition to taking supplements to increase your probiotic intake, you can eat fermented foods.

Preparations with probiotics

To eliminate constipation, probiotics are used at the first stage. They eliminate the pathogenic environment
. After them, prebiotics are taken. There are preparations containing strains of live bacteria and fiber.

The symbiosis of 2 bioactive types of substances increases the life span of beneficial microorganisms, promotes increased growth of their colonies, and accelerates recovery. Constipation goes away within 10 days.

Help to adjust the chair:

Linux. It includes 3 types of beneficial bacteria, is prescribed for the treatment of dysbiosis, and is contraindicated for people with hypersensitivity to dairy products.
Bifidumbacterin forte. Populates the intestines with “good” microorganisms and is used together with antibiotics.
Profibor. Helps fight gastrointestinal diseases and diarrhea; it is contraindicated in patients with lactase deficiency.
Bifiform. Normalizes intestinal functions.
Florin forte. Restores the balance of intestinal flora.

Bifiform for constipation

The medicine is prescribed to relieve constipation in children and adults. The composition of the medication is safe. Bifiform has no side effects
. It has practically no contraindications.

Compound

The medicine includes live bacteria that can restore the mucous membranes of the gastrointestinal tract. Bifiform is prescribed for constipation caused by low physical activity and unbalanced diet.

There are 2 types of microorganisms in tablets, capsules and powder:

enterococci;
bifidobacteria.

Sticks improve food digestion and help absorb tocopherol and folic acid. They inhibit the development of pathogens and improve microflora. As a result, the functioning of parts of the large intestine is normalized
. Feces leave the intestines naturally without encountering any obstacles.

When to use

Improving the gastrointestinal flora is the main task of the medicine. The medication is prescribed for constipation caused by:

infectious diseases that break out in the intestines;
gastritis, peptic ulcer, enterocolitis;
pancreatitis;
liver diseases;
dysbacteriosis;
use of antibiotics;
reduced concentration of enzymes;
poor digestion of food and difficulty absorbing nutrients.

The medicine is used as an auxiliary medicine for poisoning. It is used as a prophylactic after surgery and childbirth.

Review of Probiotics for Constipation

Preparations for restoring intestinal microflora are based on the work of a number of living bacteria. Medicines have different release forms and compositions. Let's consider substances (list) of mono/poly format and sorption spectrum of action:

“Bifidumbacterin” is a one-component type of drug that effectively improves immunity and improves the functioning of the intestines. The powder is suitable for a child over 3 years old. Bacteria are useful for E. coli, yeast-type fungi, classic staphylococci. The period of therapeutic action is 2 weeks.
"Laktobacterin" is a 1st generation product that includes live lactobacilli. Microorganisms produce lactic acid, creating optimal conditions for microflora. The bottles contain healing powder that helps fight intestinal infections, diarrhea and disorders of the absorption organ.
“Bifiform” is a chemical tandem of enterococcus and bifidobacteria. The substances have a beneficial effect on the digestive system. The drug is produced in the form of capsules and tablets (powder for infants);
"Acipol" is a multicomponent substance available in capsules. The medicine includes kefir fungus, lactobacilli. The compound forms optimal intestinal microflora. The medication should be taken under the supervision of a doctor who will provide prompt assistance in treatment.
"Enterol". A high-quality symbiotic contains lyophilized bacteria, monohydrates. Yeasts are eliminated from the body without problems. The product is prohibited for children under 1 year of age.
“Linex” is a sorption compound, rich in libenin, and effectively affects the synthesis of vitamins B and K. Lactic bacteria affect acidity and suppression of pathogenic structures. The product is suitable for treating infants (milk + powder).
"Probifor". The medicine has no age restrictions and consists of bifidobacteria adsorbed on activated carbon. Lactose acts as an auxiliary element. The drug removes pathogenic microflora and fights toxins. The drug is prescribed for eczema, allergies, IBS and pancreatitis. Bifidobacteria are especially useful for the intestines for constipation (bacterial spectrum of action).

Bifiform for children

The drug is used in pediatrics. It is allowed to be prescribed to children from infancy
. Bifidobacteria restore microflora and functions of the gastrointestinal tract. Bifiform helps eliminate:

digestive tract disorders;
flatulence;
colic;
symptoms of colds.

Congestion in the intestines quickly disappears. The course of treatment does not exceed 3 weeks. The child is given 1 sachet per day.

Contraindications

Bifiform is a safe remedy with no side effects. Bifidobacteria included in the medicine are similar to natural microorganisms of the intestinal flora

. The drug contains no auxiliary ingredients, so the development of allergies is impossible.

The medicine is not able to accumulate in the body. If the dosage is exceeded, excess lactic acid bacteria are eliminated naturally. In exceptional situations, individual intolerance to the drug is possible.

Bacteria included in probiotics create an environment in the intestine that leads to the death of pathogens. They do not allow germs and toxins to penetrate the blood and spread to organs and tissues.

At the same time, they strengthen the immune system, fight allergic reactions, enhance intestinal motility, promote food digestion and absorption of nutrients, and utilize food substrates. Preparations with beneficial bacteria successfully treat constipation.

According to medical statistics, a fifth of residents of developed countries experience difficulties with bowel movements. To solve the problem, measures aimed directly at identifying and eliminating the cause are necessary.
. Prebiotics and probiotics are prescribed as adjuncts for constipation in adults.

Preparations based on beneficial bacteria are often included in complex therapy for constipation.

Using probiotics for constipation

Possible common causes of constipation include dysbiosis or a violation of the ratio of beneficial and pathogenic microflora in the intestine in favor of predominance or simply increasing the concentration of the latter.

In addition to irregular bowel movements, the list of symptoms of dysbiosis includes:

diarrhea;
feeling of discomfort, bloating in the abdomen;
intestinal colic;
increased gas formation;
decreased appetite;
belching;
nausea.

Delayed bowel movements cause abdominal pain and severe discomfort

Probiotics are used for the prevention and as part of complex treatment of constipation. They help with delayed bowel movements that occur due to previous infectious intestinal diseases, taking medications to eliminate them, and impaired digestion of food. Due to the acceleration of the regeneration processes of the mucous membrane, probiotics are effective for constipation against the background of inflammatory pathologies of the digestive tract.

Note: During normal functioning of the gastrointestinal tract, the act of defecation occurs once a day. Digestive dysfunction accompanied by the absence of stool for more than 48 hours is called constipation.

When using probiotics to eliminate difficulties with bowel movements, it should be borne in mind that they have a cumulative effect and are not able to have an immediate effect. Therefore, in case of acute stool retention, their use will not be effective.

.
However, they will be beneficial for the treatment of chronic defecation regularity disorders
. The recommended course of therapy is from 2 weeks to 3 months, taking into account the severity of the condition.

Summarize

Probiotics have several beneficial properties, one of which may be treating constipation.
Research shows that probiotics may relieve constipation associated with pregnancy, certain medications, or digestive tract problems such as IBS.
Probiotics are largely safe and effective, making them an excellent addition to a healthy diet to improve bowel regularity.

Tags: Constipation, Probiotics

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The mechanism of action of probiotics for irregular bowel movements

To treat constipation, drugs containing Lactobacilli and Bifidobacteria for the intestines are used. Bifidobacteria participate in the synthesis of amino acids, vitamins, fatty acids, activate parietal digestion, protect against the penetration of microbes and toxins into the internal environment of the body, and prevent the proliferation of pathogenic and opportunistic microflora. Lactobacilli convert dietary carbohydrates into lactic acid, improve metabolic processes, and suppress the development of pathogenic microorganisms (staphylococci, E. coli, Proteus, Shigella).

In case of chronic absence of regular bowel movements, probiotics help:

improving digestion;
relieving painful discomfort in the abdominal area;
normalization of motor function of the gastrointestinal tract;
facilitating the passage of processed food due to the production of mucous substances covering the intestinal walls by beneficial bacteria;
restoration of the normal composition of intestinal microflora;
reduction of fermentation processes and gas formation.

Beneficial and harmful bacteria of the intestinal microflora

The advantages of probiotics over traditionally prescribed laxatives are good tolerability, safety, absence of side effects and addictive effects.

Recommendation: To eliminate untimely bowel movements, it is important to make changes in lifestyle, normalize the drinking regime, increase physical activity, the amount of fresh vegetables, fruits, and fiber-rich foods in the diet.

Constipation due to dysbiosis in a child

Due to the immaturity and lack of its own immunity, the child’s body is susceptible to various diseases. Intestinal dysfunction occupies one of the leading places among them. Disturbance of microflora can be primary in nature, when the large intestine is colonized by pathogenic microorganisms immediately after birth. The most common variant is a secondary pathology that arises as the child grows older.

The cause of dysbiosis is influenced by various factors

The main causes of childhood dysbiosis lie in:

late breastfeeding;
early start of artificial complementary feeding;
low-quality formulas for feeding;
infectious diseases;
use of antibacterial therapy;
infection with worms and other parasites;
improper diet;
low immunity.

If an adult can ignore unpleasant symptoms for a long time, then in a child the clinical picture is more vivid and manifests itself already at the initial stage:

increased gas formation;
belching;
bloated and painful belly;
rumbling in the stomach;
irregular bowel movements;
prolonged absence of stool;
refusal to eat;
temperature increase;
skin rashes;
moodiness, tearfulness, restlessness.

In infants and small children, frequent changes in feeding formulas lead to an imbalance in the balance of beneficial and harmful bacteria.
Can there be constipation if a child has dysbiosis? Constipation, as well as diarrhea, are major signs of concern. Normally, a baby has 2 to 7 bowel movements per day; as they grow older, the number of bowel movements decreases to 1-2 per day, but not less. In case of defecation disorders, especially prolonged constipation due to dysbacteriosis in infants, you should immediately contact your pediatrician.

Drugs that promote the proliferation of beneficial microflora for constipation

Prebiotics are among the drugs that create favorable conditions for the development and reproduction of beneficial intestinal microflora and provide a breeding ground for it. For constipation, they are often prescribed as mild laxatives.

The mechanism of their action is due to:

improvement of gastrointestinal motility;
softening of stagnant feces by increasing the water content in them;
increased secretion of bile into the lumen of the small intestine;
an increase in the volume of feces, stimulation of the urge to defecate;
binding and removing accumulated waste and toxins;
relief of the painful act of defecation.

Action of lactulose

If you have difficulty bowel movements, it is better to take prebiotics, since, compared to probiotics, they have a quick action. To eliminate constipation, both acute and chronic, drugs based on lactulose (Duphalac, Normaze, Lactusan) are most often prescribed.

.
They have a mild effect, do not damage the colon mucosa, inhibit the growth of pathogenic bacteria, and stimulate the reproduction of beneficial microflora (Bifidobacteria and Lactobacilli)
. After taking drugs with lactulose, the laxative effect develops after 24–48 hours.

Sometimes, if you have irregular bowel movements, it is advisable to use medications that contain both pro- and prebiotics. They promote increased growth of colonies of beneficial microflora.

Taking medications for delayed and difficult bowel movements, despite the sensitivity of the problem, should be agreed with a doctor. It must be remembered that self-medication can aggravate the situation and provoke the development of complications (hemorrhoids, anal fissures, inflammation of the intestines, the appearance of pathological formations).

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Impaired bowel function can cause constipation. One of the reasons for the malfunction of the digestive tract is dysbiosis - a decrease in the amount of normal intestinal microflora and its colonization by pathogenic microorganisms. This may be accompanied by unpleasant symptoms such as abdominal pain, flatulence, and a feeling of incomplete emptying.

. Probiotics for constipation in adults will help solve existing problems.

The effect of probiotics on various types of constipation

Probiotics have been studied for their effect on constipation in a wide variety of diseases and conditions.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a gastrointestinal disorder that can lead to numerous symptoms, including abdominal pain, bloating, and constipation ().

Probiotics are often used to relieve symptoms of IBS, including constipation.

One review of 24 studies found that probiotics reduced the severity of symptoms and improved bowel habits, relieved bloating, and improved quality of life in people with IBS ().

Another study of 150 people with IBS found that taking probiotics for 60 days helped improve bowel regularity and stool consistency ().

Moreover, in a 6-week study of 274 people, drinking a probiotic-fortified fermented milk drink increased the frequency of bowel movements and reduced symptoms of IBS ().

Constipation in children

Constipation in children is common and can be caused by a variety of factors, including diet, family history, food allergies and psychological problems ().

Numerous studies show that probiotics relieve constipation in children.

For example, a review of 6 studies found that taking probiotics for 3 to 12 weeks increased bowel movement frequency in children with constipation, while a 4-week study of 48 children linked the supplement to improved bowel movement frequency and consistency (, ).

However, other studies provide mixed results. Thus, more research is needed ().

Pregnancy

Up to 38% of pregnant women experience constipation, which can be caused by prenatal supplements, hormonal fluctuations, or changes in physical activity ().

Some research suggests that taking probiotics during pregnancy may prevent constipation.

A 4-week study of 60 pregnant women with constipation found that daily consumption of 300 grams of probiotic yogurt fortified with Bifidobacterium and Lactobacillus bacteria improved intestinal motility and relieved some symptoms of constipation ().

In another study of 20 women, probiotics containing a mixture of bacterial strains increased the frequency of bowel movements and relieved constipation symptoms such as straining, abdominal pain, and the feeling of incomplete bowel movements ().

Medications

Several medications can cause constipation, including opioids, iron pills, antidepressants, and some types of cancer drugs (,).

Chemotherapy in particular is a leading cause of constipation. About 16% of people undergoing cancer treatment suffer from constipation ().

In a study of nearly 500 people with cancer, 25% reported relief from constipation or diarrhea after taking probiotics. Meanwhile, in a four-week study of 100 people, probiotics relieved chemotherapy-induced constipation in 96% of participants (, ).

Probiotics may also help those who experience constipation caused by iron supplements.

For example, a small two-week study of 32 women found that taking a daily probiotic along with an iron supplement increased bowel regularity and improved bowel function compared to taking a placebo ().

However, more research is needed to determine whether probiotics can help with constipation caused by other medications such as antidepressants.

Summary:
Research shows that probiotics can treat constipation in adults and children, as well as in pregnant women, people with IBS, and people taking certain medications.

What are probiotics

Probiotics are medications containing beneficial bacteria necessary for the normal functioning of the gastrointestinal tract. With constipation, digestion is disrupted, fermentation and putrefaction processes can occur in the intestines, toxins are formed, which are absorbed in large quantities into the blood.

Microorganisms found in medicines populate the intestines and contribute to the normalization of digestive processes. The same bacteria are found in lactic acid products, which are also recommended for patients with constipation.

Probiotics contain the following types of bacteria:

lactobacilli strains;
bifidobacteria;
non-pathogenic Escherichia coli;
yeast mushrooms;
lactic acid streptococcus.

Some drugs contain strains of only one type of bacteria, while others are combined products.

The mechanism of action of living bacteria on the intestines and the functioning of the gastrointestinal tract

The digestive tract is a microbiocenosis that provides complete protection and development of the body. The human gastrointestinal tract accumulates a huge number of microorganisms that form healthy microflora. The microbiocenosis of the absorption organ is represented by lactic acid and bifidobacteria.

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The mechanism of action of probiotics has the following algorithm:

change in the structure of proteins foreign to the body. The probiotic is able to destroy casein in cow's milk, regulating the immunological properties of the body. Cleaved protein is not able to enhance intercellular metabolism, especially in children,
reducing the amount of inflammatory mediators in the intestines. Probiotic agents reduce the likelihood of developing necrosis and alpha tumors. Atopic dermatitis does not develop with complex treatment,
gastric/intestinal permeability format, which decreases,
the antigen affects Peyer's patches and promotes uptake. Lactobacilli influence the process of interferon generation.

Compounds on spores of the Bacillyscoagulans format have increased resistance to dissolution. The shell can withstand the effects of stomach acid, high temperature, and bile. When it enters the human body, the substance quickly spreads through the intestines.

The production of lactic acid helps normalize the digestion process. The probiotic has no contraindications and is safe for different age groups.

Impact on the intestines

Probiotics for the intestines perform a number of very important functions:

improve the digestion of proteins, fats and carbohydrates in the intestines;
normalize intestinal motility, thus accelerating the movement of feces through the gastrointestinal tract;
local immunity improves, the body becomes resistant to many intestinal infections;
break down salts of fatty acids;
pathogenic microflora is destroyed, including Helicobacter pylori, which is responsible for the development of peptic ulcers.

On the way to the intestines, probiotic bacteria are destroyed by gastric juice and bile enzymes, so only a small part of them reaches the colon. However, microorganisms have a high ability to multiply and quickly suppress the growth of pathogenic microflora.

Taking probiotics for constipation helps soften stool, move it faster through the intestines and make bowel movements easier.

Why Probiotics Are Essential for Treating Constipation

Pharmacological preparations with live bacteria are intended to eliminate microflora imbalance and cure constipation.

Lactobacilli multiply in the small intestine and prevent the negative effects of harmful microorganisms. Bifidobacteria contribute to the normal functioning of the digestive tract, improve metabolism, and activate the immune system.

The gastroenterologist selects medications individually for each patient, in accordance with the disease that caused constipation. Disturbances in the passage of feces are caused by the following pathologies:

the formation of inflammatory infectious foci in various parts of the intestine;
diseases requiring the use of antimicrobial drugs;
intoxication with food, household chemicals, plant poisons;
irritable bowel syndrome;
decreased functional activity of the urinary system;
allergic reactions, including autoimmune systemic diseases.

In all these cases, in addition to drug therapy to eliminate the underlying cause of the disease, probiotics are used.

Indications for use

Since probiotics are medications, they should only be taken as prescribed by a doctor. Despite the fact that these drugs mainly affect the intestines, they are used for a wide range of diseases, the most common of which are:

intestinal dysbiosis;
frequent diseases of the ENT organs (sinusitis, otitis, pharyngitis, bronchitis);
allergic diseases (bronchial asthma, polynosis);
long-term use of antibacterial drugs;
helminthiases;
gynecological diseases caused by disruption of the normal microflora of the vagina;
lactose intolerance (lactic acid products);
intestinal infections;
diseases of the gastrointestinal tract (peptic ulcer, cholecystitis, colitis, pancreatitis);
irritable bowel syndrome.

Probiotics are taken in courses of several weeks, followed by a break of 1-1.5 months. Usually the drugs are recommended to be taken on an empty stomach or after meals.

Choose on your own or see a doctor?

To purchase a probiotic or prebiotic, you just need to visit the pharmacy, say the name of the medicine you need, and they will sell it to you, because they are dispensed without any restrictions and without a doctor’s instructions. If you have made your own diagnosis and decided to start taking a course of probiotics, then follow these recommendations:

Always read the label. Carefully study the label, review the instructions, pay attention to the strains and their expiration dates.
Seek the truth. What is stated on the label is often not true; call the manufacturer and find out what strains were used. You can also visit the website.
Trust only high quality products. You should not give preference to unknown manufacturers.
Store your food correctly. Don't focus your attention only on medications, think about the conditions under which your food is stored.

You should consider taking probiotics if you have irritable bowel syndrome, inflammatory processes, or infectious diarrhea.

And don't use probiotics as a constipation tool just because they helped someone else. We must not forget the fact that the reasons are different for everyone.

Types of probiotics

Depending on what bacteria are included in the probiotic tablets, the preparations are divided into:

Containing lactobacilli (“Linex”, “Acipol”, “Biobakton”).
Bifido-containing (“Bifiform”, “Probifor”).
Enterococcal - judging by the name, contain only intestinal cocci, mainly represented by dietary supplements.
Coli-containing – contain Escherichia coli (“Colibacterin”, “Bioflor”).
Containing non-pathogenic yeast fungi - “Enterol”, “Sporobacterin”.
Combined preparations containing several types of bacteria (“Hilak Forte”).

To treat dysbiosis, a list of probiotic preparations can be used; first it is recommended to take lactobacilli, then bifido-containing agents and others.

Linex

It is one of the best probiotics for constipation caused by impaired intestinal microflora. Contains three strains of lactic acid bacteria necessary for proper digestion

. The preventive and therapeutic effect of the drug is due to the following factors:

the breakdown of milk sugar increases the pH of the intestinal environment and makes it acidic, which helps destroy pathogenic microflora;
lactobacilli participate in the synthesis of vitamins B and K and promote their absorption through the intestinal wall;
helps improve the metabolism of bile acids and pigments;
does not allow pathogenic agents to gain a foothold on the intestinal wall;
improves local immunity;
has a bactericidal effect against pathogenic flora.

The adult dose is 2 capsules 3 times a day after meals. For children, reduce the amount of the drug by 2 times. The duration of treatment depends on the cause of stool retention and is determined by the doctor.

If you or your child do not drink the whole capsule, you can open it and mix the contents with a small amount of liquid.

Hilak Forte

Another representative of effective drugs for the treatment of constipation. It is a combined product that includes several types of bacteria (enterococcus, lactobacilli and non-pathogenic Escherichia coli). Available in the form of drops with a pleasant smell and taste, which is especially convenient when administered to children.

It also changes the pH of the intestinal environment, which causes the death of pathogenic microflora and stimulates the regeneration of enterocyte cells. As a result of using the drug, stools are normalized, pain and discomfort in the abdomen disappear, and allergic manifestations (if any) disappear.

The drug is resistant to most antibiotics, so it is advisable to prescribe it together with bactericidal agents.

Please note that the drug is prescribed with caution for hyperacid gastritis and peptic ulcers, as the drug increases acidity.

Adults take 40-60 drops of the drug and children take half of this dose.

Bifidumbacterin

The drug contains live bifidobacteria. These microorganisms help normalize digestion through antagonistic activity against pathogenic flora, participate in many biochemical processes in the intestine, and also improve immunity.

Thanks to the properties of bifidobacteria, the probiotic finds its use not only in the treatment of constipation and other pathologies of the gastrointestinal tract. It is actively prescribed by gynecologists (intravaginal administration), allergists, and neonatologists (for premature babies).

For adults and children suffering from constipation, the drug is prescribed 5 doses 2-3 times a day. The duration of treatment is determined by the attending physician.

The effect of taking the drug occurs a week after the start of use. To prepare one dose of the drug, mix the contents of the bottle with 1 teaspoon of warm liquid.

Do not use too hot water - bacteria may die.

Enterol

Enterol contains Saccharomycetes fungi, which are involved in the breakdown of carbohydrates in the intestines. The probiotic effect of the drug is due to:

antimicrobial effect against pathogenic intestinal microflora;
participation in binding toxins and preventing their absorption through the intestinal wall;
increased production of IgA - a specific immunoglobulin of the mucous membranes;
improving the nutrition of the intestinal wall due to the production of specific substances;
participating in the breakdown of complex carbohydrates and preventing fermentation processes in the intestines.

For children and adults, the drug is prescribed in a dose of 1-2 sachets (capsules) per day.

Treatment of constipation with the drug is carried out from 5 to 14 days, depending on the severity and severity of the symptoms of the disease.

Microbiological aspects in the treatment of constipation

The development of all higher organisms was carried out in the presence of bacteria, one of the oldest forms of life on Earth, which led to the closest connections between them [14]. Therefore, all body tissues in contact with the external environment are habitat niches for a wide range of microorganisms that form biological films. The quantitative and qualitative composition of microbial associations is controlled, on the one hand, by the “quorum sensing” system, which allows bacteria to exchange information through the diffusion of signaling molecules that regulate the expression of bacterial genes when achieving optimal cell density [2], on the other hand, the host tissues of the macroorganism have the ability to optimize microbial ecosystems through the production of antimicrobial peptides [14]. The complexity of these relationships is complemented by the influence of microorganisms on the functioning of the organ-environment in a manner favorable to themselves, through the expression of messenger molecules for various intercellular signaling pathways of the macroorganism, and the correct maturation of the human immune system is largely mediated by the influence of representatives of its microflora [29].

The composition of the microflora of each person is individual, like fingerprints [3], and this individuality can be explained by the characteristics of immune reactions, feeding, lifestyle, past infections and means of treatment, as well as existing chronic pathology [7, 32]. A decrease in the activity of intestinal motor function, manifested by constipation, also has a significant effect on the composition and topology of the intestinal microflora [10]. Food debris that is not removed in time can serve as a substrate for individual microorganisms and is an important advantage in the competitive struggle of bacteria. In addition, regular use of laxatives and enemas by patients with constipation may also affect the composition of the intestinal microflora. Thus, adult patients with constipation are characterized by a decrease in the number of bifidobacteria and lactobacilli with an increase in Veillionella species [10], while children are characterized by an increase in the number of clostridia and bifidobacteria [19, 24]. In some studies, a course of antibiotic therapy increased stool frequency, improved stool consistency, and eliminated straining, which confirmed the role of microflora changes in the formation of constipation [24].

Some light on the mechanism of the connection between intestinal flora and constipation can be shed by studies in which, in patients with irritable bowel syndrome (IBS) with constipation, a hydrogen breath test with lactulose revealed a significant increase in methane production, associated with an increase in intestinal transit time [23]. Under experimental conditions, methane inhibited the motor function of the intestine by increasing its tone [23]. Moreover, it should be emphasized that the source of excess amounts of methane in the exhaled air of patients with constipation has not yet been determined and some researchers believe that they are methane-forming bacteria of the colon, not the small intestine [24]. Thus, therapeutic measures aimed at correcting the microbial composition in patients with constipation can help restore intestinal transit time and maintain a state of remission for this indicator.

Treatment of chronic constipation should be carried out in conditions of lifestyle correction with the obligatory elimination of factors contributing to stool retention. To achieve success in a large proportion of patients, it is enough just to provide an immediate response to the onset of urge and restore the bowel habits during the day and in relation to meals [6]. Increasing the level of physical activity may help in cases of mild constipation, but in the case of prolonged absence of stool, this measure is ineffective [6]. Increasing fluid intake does not have a significant effect on the rate of intestinal transit and in the absence of signs of dehydration this recommendation is ineffective [6].

Dietary fiber has been used in the treatment of constipation for about 500 years and is overwhelmingly non-starch polysaccharides. Water-soluble fibers (pectin, gums and mucus) are able to form viscous solutions and retain water in the intestinal contents, increasing its volume and having little effect on transit time, insoluble fibers (cellulose, hemicellulose and lignins) are not able to retain water, but significantly increase the volume of stool and significantly stimulate intestinal transit [6, 24]. The inverse relationship between dietary fiber solubility and increased stool weight is explained by the greater susceptibility of soluble fiber to bacterial fermentation in the proximal colon. The laxative effect of dietary fiber is provided by the swelling of undigested fiber, fluid retention in the intestinal contents, the prokinetic effect of bacterial fermentation products (butyrate), stimulation of the growth of bacterial mass (which represents the dry mass of feces), increased production of gases and other by-products of fermentation that increase stool weight [24]. ]. In healthy volunteers, the effect of 25 g fiber on stool weight varied widely, from +17–19% with pectin and gums to +117% with bran [24]. As is known, some patients with constipation are resistant to the laxative effect of dietary fiber, and this resistance turned out to be directly proportional to the increase in intestinal transit time [24]. Recommendations to increase fiber content to 10–20 g per 1000 kcal of diet [6] are extremely common, but their evidence base is weak: modern systematic reviews describe the effect of fiber on stool frequency as modest at best, with an effect in placebo-controlled studies soluble fiber (psyllium) on stool frequency and consistency was described as positive, while bran failed to demonstrate a significant positive effect in similar conditions [24]. The lack of large, well-designed studies on the use of dietary fiber in the treatment of constipation limits its use in risk groups such as elderly patients and patients with neurological diseases. Although high-fiber foods and medications are free of serious side effects, their palatability (especially bran) and tolerability issues due to fermentation and gas production are major barriers to their use in IBS patients with constipation, who often associate the presence of symptoms with food intake, since the inclusion of insoluble fibers can provoke pain [24]. Adjusting the proportions between soluble and insoluble fibers may help overcome the problem of intolerance in these patients [6]. Based on a generalization of application experience, we can conclude that biologically active supplements (BAA) and food products containing dietary fiber are effective in patients with chronic constipation without delayed transit and pelvic floor dyssynergia, and in this group their effectiveness reaches 80% [6] .

Prebiotics are fermentable foods that exert their beneficial effects on the health of the host by selectively stimulating the proliferation and activity of certain types of bacteria in the colon. Of the prebiotics, only inulin and fructooligosaccharides have sufficient evidence for their use as ingredients in functional foods; they are fermented in the colon to produce energy and end products such as lactic acid and short-chain fatty acids [24]. It should be borne in mind that dietary fiber and lactulose, widely used for constipation, also have prebiotic properties. There are very few studies in the literature on the effect of prebiotics on stool retention with a satisfactory design, and when interpreting the results obtained, the influence on the microflora from food ingredients should be taken into account, since polymeric carbohydrates with prebiotic properties are widely distributed in fruits, vegetables and cereals [6] .

Relatively recently, in addition to pathogenic and fermenting bacteria, human symbiotic microorganisms came into the sphere of interest of microbiologists, when the significant influence of these microorganisms, especially intestinal microflora, on the health of the host organism was established, which contributed to the formation of the concept of probiotics. I. I. Mechnikov was the first to formulate this idea, believing that lactic acid bacteria are the most suitable candidates for the role of probiotic microorganisms. But during the heyday of antibiotics and vaccines, this idea did not receive due attention, and only the emergence of multi-resistant strains and awareness of the role of human microflora in maintaining health contributed to a surge of interest in this concept. A working group of the World Health Organization in 2002 adopted a definition of probiotics as “live microorganisms that, when administered in adequate quantities, contribute to improving the health of the host” [31].

The bulk of probiotic products currently on the market belong to a large group of lactic acid bacteria, which are normal representatives of the microflora of the human gastrointestinal tract (Table 1) [22]. However, numerous researchers are exploring the potential probiotic capabilities of other microorganisms, such as yeast, that are not normally present in the human intestine [25].

Probiotic strains exert their health benefits through multiple mechanisms unique to each strain (Table 2) [22], and the interaction space between the probiotic and the host can be divided into three levels: 1) the intestinal lumen, 2) the intestinal epithelium, and 3) immune system [27]. However, the mechanisms for implementing a significant part of the described effects of probiotics have not been fully disclosed.

It has now become known that probiotic bacteria are able to interact with the cells of the host organism by interfering with the functioning of intercellular signal transmission pathways [22]. Secreted bacterial products (peptides, short-chain fatty acids, bacteriocins, nitric oxide) [12, 18, 30, 31] and structural components of dead bacteria (DNA, proteins, lipopolysaccharides) [5] are capable of causing a specific response from the human body, for example, altering the activity of the transcription factors NF-kB and AP-1 either through mitogen-activated protein kinases (MAPKs) or protein kinase C and phosphatidyl-inositol 3-kinase [22, 28].

Gram-positive bacteria use N-acyl-homoserine lactones and 2-alkyl-4-quinolones as signal molecules, while Gram-negative bacteria use peptides capable of forming cyclic structures that ensure the functioning of the “quorum sensing” system [2]. Some of these molecules interact with cell surface receptors, others have receptors intracellularly, and some of these molecules have recently been shown to have immunomodulatory properties [33].

In relation to constipation, there are several clinical studies in which probiotics (sometimes in combination with a prebiotic) have been shown to speed up intestinal transit in patients with slow transit. Thus, Bifidobacterium animalis reduced intestinal transit in healthy women, elderly patients and patients with IBS [24]. This effect was observed only when using live microorganisms and was more pronounced in individuals with an initially pronounced slowdown in transit. In individuals with IBS, this acceleration of transit was most pronounced in the right side of the colon, which contains the highest density of bacterial contents [24]. Upon closer examination, the acceleration of transit was found to be independent of changes in fecal mass and bile acid content, implying a direct effect of the probiotic on intestinal motility [24]. Other researchers were able to prove the ability of a combination of Lactobacillus ramnosus, B. lactis and inulin to stimulate the motor function of the small intestine [24]. Another way probiotics influence the functional activity of the intestine may be mediated by the central nervous system. The connection between anxiety and depressive disorders and disorders of intestinal motor function has now become indisputable, and the presence of constipation in a patient always requires the exclusion of emotional disorders [15]. Animal studies have found that the introduction of Bifidobacteria infantis into the diet of rats for 14 days contributed to a significant increase in the level of tryptophan in the blood plasma, which is a precursor of neurotransmitters (serotonin) in brain cells, which was regarded by the authors as the presence of antidepressant potential in these bacteria [10, 13].

Among the published data from randomized controlled trials, a positive effect in patients with chronic constipation (without the presence of IBS) was noted when using a probiotic drink containing Lactobacillus casei Shirota, as well as the probiotic strain B. lactis DN-173010 [6]. In children with functional constipation, under placebo-controlled conditions, administration of L. reuteri significantly increased stool frequency, but without a significant change in stool consistency [11]. Normalization of bowel movements in nursing home patients has been achieved using B. longum [6]. Other studies with less rigorous designs or combinations of probiotics and other treatments have shown encouraging results for bifidobacteria, lactobacilli, propionobacteria, and fecal suspension infusions [17, 24]. In a meta-analysis of the effectiveness of probiotics for constipation, including five studies with 377 participants, a positive effect on stool frequency and consistency was obtained with the use of B. lactis DN-173010, L. casei Shirota and Escherichia coli Nissle 1917 [9].

Strong support for the concept of using probiotics for stool retention comes from studies on IBS [16]. Bifidobacterium animalis, in addition to reducing intestinal transit time, significantly increased stool frequency in patients with IBS with constipation. Another strain of B. infantis 35624 was able to normalize stool consistency and reduce the need to strain in patients with IBS, without significantly changing stool frequency [21].

Recent reviews [6, 25] have emphasized the fact that administration of L. rhamnosus GG has been found to be ineffective when used in patients with constipation. These studies refer to a placebo-controlled study by Polish researchers [4], who found no additional effect on stool parameters when adding this probiotic to a lactulose treatment regimen in a pediatric population (n = 84). While in earlier work involving adult patients with constipation, L. rhamnosus GG showed a positive effect on stool count [20]. Possible reasons for the lack of effectiveness of this strain in children may be some errors in the study design: patients received the probiotic in the form of capsules, and they were allowed to open them and add the contents to food (knowing the dislike of children for tablets and capsules, it can be assumed that most children opened them — this indicator, unfortunately, was not taken into account in the study). As it became known relatively recently [26], the effectiveness of a probiotic strongly depends on the fat content, the concentration and type of protein and monodisaccharides, as well as the pH of the carrier medium. Fermented milk drinks, where these parameters are most successfully balanced, are recognized as the optimal means of probiotic delivery. Also, the researchers absolutely did not take into account the composition and quantity of food eaten, which could have a decisive influence on the frequency and consistency of stool.

As an alternative point of view, we can refer to our study performed two years ago [1]. The study included 60 inpatients with IBS with constipation (Rome III criteria), who were randomized into three groups similar in age, presence of underlying and concomitant diseases. In group 1, the diet was modified by replacing kefir and sour cream with 330 g of the studied drinking yogurt Bio Balance®, enriched with bifidobacteria and L. rhamnosus GG (ATCC 53103, LGG®), with a CFU content at the end of the shelf life of at least: bifidobacteria - 106 , lactobacilli - 107. The basic diet of patients of the 2nd group is modified by replacing kefir and sour cream with 330 ml of Bio Balance® kefir drink, enriched with probiotics according to a similar scheme, with a CFU content at the end of the shelf life of at least: bifidobacteria - 106, lactobacilli - 106. The control group consisted of patients who received a standard diet with traditional fermented milk products. It is worth noting that the consumption of homemade products is not allowed by the Clinic's rules, so the differences in the diets of the participants were minimal. The duration of the clinical trial was 21 days. The groups were compared in terms of the dynamics of quality of life and severity of complaints, in terms of stool consistency indicators indicating its frequency, and microbiological analysis data. Patients noted greater satisfaction with the quality of bowel movements, and it is worth noting that in the group that consumed fortified yoghurts and kefir drink Bio Balance®, better dynamics of this complaint were noted (-1.1 on a 5-point Likert scale, p = 0.01) than in patients of the control group (-0.45 at p = 0.05). Only in the group that consumed the studied yogurt and kefir drink Bio Balance®, there was a significant improvement in stool consistency (+0.95, p = 0.01 and +0.68, p = 0.01 Bristol stool scale), an increase in stool frequency was more pronounced than in the control group (+0.24 times/day, p = 0.05 versus +0.13 times/day, p = 0.05). The differences in the dynamics of quality of life indicators between the groups were insignificant. Only in patients who received the studied kefir drink Bio Balance®, a significant increase in both lacto- (+2.2 lg) and bifidobacteria (+1.7 lg) was observed; in patients who received fortified yogurt Bio Balance®, only growth of lactobacilli (+3.1 lg), and in the control group at the end of the observation period there was an increase in the content of bifidobacteria (+2.7 lg), which emphasizes the connection between changes in the clinical picture and the activity of the probiotic.

Thus, the exclusion of L. rhamnosus GG (ATCC 53103, LGG®) from the list of probiotic microorganisms effective for constipation seems premature and requires studies with a more reliable design.

Conclusion

Chronic constipation is an extremely common disease worldwide that can seriously impair the quality of life of both adults and children. Only 60% of patients with constipation are satisfied with the effectiveness of laxatives, and a significant proportion of them require long-term maintenance treatment [11]. The widespread use of dietary fiber in people with chronic constipation or IBS sometimes leads to discouraging results: insoluble dietary fiber, despite the most pronounced effect on stool frequency, may be contraindicated in patients with IBS due to increased bloating and abdominal pain. The unconditional importance of intestinal microflora for the normal functioning of the small and, especially, large intestine in the presence of changes in the microbial landscape in people with constipation provides sufficient grounds for the use of pro- and prebiotics in the treatment of chronic constipation and IBS. It seems very attractive the idea of widespread use by various segments of the population of food products enriched with effective probiotic strains for the treatment and prevention of stool retention, which is accurately reflected in the words of the great Hippocrates: “let my food become medicine...”, and, it should be noted, a safe medicine! To determine the most optimal strain and type of probiotic in a sufficient dose for each variant of chronic stool retention, as well as the selection of a carrier medium, it is necessary to conduct high-quality studies in design involving a large number of patients.

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V. I. Pilipenko, Candidate of Medical Sciences D. A. Teplyuk A. K. Shakhovskaya, Candidate of Medical Sciences V. A. Isakov, Doctor of Medical Sciences, Professor of the Research Institute of Nutrition of the Russian Academy of Medical Sciences, Moscow

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