Constipation ( Anak saya sembelit )


Q:  hi paediatrician. my son is now already 3 yrs old – having chronic constipation since 6 months old.. already done investigation including rectal biopsy – all normal.. very difficult for toilet training as mom working hehehhe… diet pun susah.. heard that probiotics can help for habitual constipation and which brand is the best? what is ur advice? now dependent on syr lactulose. ( Noor Suria )

A:  Hello there Noor, constipation in children is pretty common. In fact, it is one of the most common complaint I encounter in clinic. I understand it must be rather frustrating, especially when your child has had this for a very long time. It seem that all the necessary work up has been done to rule out pathological causes. Therefore, the likely reason for his condition is ‘functional constipation’.

For the benefit of other readers, constipation is defined as having less than 3 complete bowel movement a week and the stool are often hard. The child often finds it difficult to pass motion and he/she often strain at stool.Sometimes, there may even be some bleeding.

In your child’s case, it seem that you have tried diet modification which I assumed includes lots of fibre and water. It is also important that this needs to be coupled with lots of exercise. The NICE (UK) Guideline recommends physical activity for at least one hour a day , and I believe being a 3 year old boy, your child probably has done  tripple or more  of the recommended hour ! : )


Anyway, it is important to realize that kids with chronic constipation has stool retention and often withold their stool as well and as a result constipation continue as a vicious cycle. I’m assuming that he has been assessed for fecal impaction.

It is imperative that your child  feel that passing motion is not painful or else he would continue to withold his stools as he fear the pain that it causes and the constipation becomes a never-ending story. Hence I would often advise parents to continue laxatives e.g lactulose  as maintenance therapy for some time with the aim of producing soft, painless stool to prevent reaccumulation of feces. With time, the child forgets his ‘painful experience of passing hard stool’ and would stop witholding it , thus potty training becomes a lot easier.

The other important aspects of treating constipation is behavioural intervention. This includes scheduled toileting and the use of rewards and encouragement system. It works best when coupled with other interventions because that alone wont help.

I wonder if your child drinks a lot of milk because that too can be a contributing factor. In certain severe cases, cow’s milk exclusion diet helps for those who do not respond to adequate medical and behavioural management, but often with advice of the attending paediatrician.


Anyway, back to your questions on Probiotics. Probiotic is food or oral supplement that contains sufficient number of viable micro-organism to alter the microflora of the host for health benefits. It is available in infant formula, yogurt and oral supplements. A point to remember is that there is a wide variations in potency and quality, and that not all strains of probiotic bacteria are effective for treating constipation . Although, the effectiveness of probiotics on gastroenteritis and antibiotic associated diarrhoea have been established, there is inconsistent data on the effectiveness  in children with constipation. Having said that, I personally feel that it is worth trying but find one that contains different strains of probiotics. You may ask the pharmacist for multiple strains probiotics (due to conflict of interest, i am unable to name the brand). Alternatively, you may want to try giving yogurt twice a day and see if that helps.

The objective is to treat constipation and prevent it from recurring. Therefore, the combination of all these is important.  Hope you find this helpful. Cheers!

( Answered by Dr Zahilah Filzah )


13 responses to “Constipation ( Anak saya sembelit )”

  1. emezza Avatar

    Doc..anak saya berusia 1bulan + 10 hari..dejak lahir dia cmpur bf n fm selama 1mggu..dan slps tu fully fm…sblm ni saya bg susu kambing (karihome) dia berak 4 jari lepas saya tukar ke similac dia berak keras 1st day n berak sgt byk 2 day.. hari ke -3 n ke -4 dia xberak..perut lembut tp sedikit kembung.. skrg saya tukar balik ke susu kambing… mcmmne nk buat aanak saya berak? Risau..

  2. ana Avatar

    Hi doc, anak saya baru 24 hari, saya beri dia susu formula ( anmum) Saya dapati beraknya keras , bagaimana untuk melembutkan najisnya?. Adakah dibolehkan mengurangkan sukatan susu dibenarkan dalam mengatasi masalah berak keras ini?. ( contoh 2 scope untuk 2 oz….saya kurangkan 1 scope utk 2oz air). tq

  3. ila Avatar

    Hi doc, anak sy 1y10mnths c.a 1y7mnths…she prem bb @26weeks.dia start constipation since age 9mnths br dia start mkn…doc pernah suspek ischprung disease but -ve the result..doc kata usus dia
    xmatang lg…tp smpi skrg dia suffer nk b.o bile sehari x
    membuang…confirm the next day dia b.o ada darah…she’s on lactulose 5mls on,& ravin enema when necessary…everyday i gve food n vegetable but still constipate.apa yg i perasan kt stool tu,apa yg dia mkn x digest pun.for example i gve carrot,mmg keluar carrot yg dia gigit2 tu.sampai bile akan pulih ye…what should i do doc?

  4. Koh Avatar

    My baby now 2 month plus. During the 1st month fully breast feeding, she pass stool 6 to 8 times everyday. Come to 2nd month still fully breastfeeding, but she pass stool once 3 to 10 days. Till today about to 3 months, she still pass stool once 3 to 10 days, and she always cry and seemed not comfortable. The amount of stool quite a lot, the tummy is soft and growing ok but always crying and cannot sleep especially at night time…. what should I do?

  5. Dr Zahilah Avatar
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  6. hanna Avatar

    hai saya ingin bertanya. kalau anak saya campur susu (susu badan + susu fm). adakah normal untuk buang air besar dalam masa 3 atau 4 hari sekali. tapi saya tgk anak sy ok. selalu kentut, perut tak kembung. adakah sy perlu tukar susu. sebab sekarang ni anak saya minum susu frisolac. sebelum ni anak saya minum susu Dumex, tapi saya tukar sebab rasanya yg agak manis.

    1. doktorbudak Avatar

      Hanna, sekiranya najisnya lembut maka ia bukanlah sembelit . Menukar susu formula adalah tidak perlu.

  7. belle Avatar

    Hi dr. My nephew is 3 month – old boy. He’s been having constipation for quite some time. Otherwise, he is feeding and gaining weight well. His stool wasn’t hard stool. Does this has something to do with the formula milk that he is talking? Or because of frequency as u mentioned before? In this case, what to do dr. Since he is just 3 month – old boy. Thanks in advance 🙂

    1. Avatar

      Constipation is passing of hard stool infrequently. Was he on formula since birth or just changed? Is he still on breastmilk? Breastfeeding babies normally pass stool every once 1 in 2-8 days when they are about 2-3 months of age. If he is well, growing , no vomiting and the tummy is soft , this is not worrying taking into account he previously had normal frequency stool after birth and pass stool within 24 hours after birth. if its otherwise do a check up because there are other causes of constipation like hormonal problem , intestine problem etc

  8. pinkwatch Avatar

    indeed a very good article! Good job Dr Zahilah!

    pemakanan yogurt ni pon sangat bagus utk org dewasa yang menghadapi masalah sembelit dan juga gastrik. Saya pon mengamalkannya utk sembelit dan gastrik saya. 🙂

    1. doktorbudak Avatar

      Thank you.

  9. doktorbudak Avatar

    Dear Ainee, glad that your child is getting better. Constipation is painful for the child and disheartening to the mother.

    Zahilah F

  10. ainee Avatar

    thank you for answering this. happened to my first born. he was breastfed and kind of phobia when he needs to pass the stool. diet, medicine and milk choice are important. nowadays I give him pediasure milk once before bed. and alhamdulillah he needs not to depend on lactulose anymore and less pain when passing stool.