"Should I Give Ex-Lax to My Constipated Child?"

By Steve Hodges, M.D.

Many parents are told Ex-Lax isn’t safe for children. The research — and my clinical experience — say otherwise.

This post was updated in March, 2026, to reflect Dr. Hodges' current treatment recommendations.

By Steve Hodges, M.D.

I get a lot of questions about Ex-Lax.

Parents want to know: Is it safe? Is it better than Miralax? Can children take it long-term? Will my child develop dependence? Can Ex-Lax be used instead of enemas?

Stimulant laxatives such as Ex-Lax (senna) make many parents nervous, and some doctors oppose using these laxatives for more than a few days. In my experience — and based on the published research — these cautions are unfounded. Ex-Lax is safe for children and, when timed and dosed appropriately, can be a uniquely useful tool for children with chronic constipation, enuresis (daytime or nighttime wetting), or encopresis (chronic poop accidents).

That said, Ex-Lax is rarely the whole solution for children clogged up enough to have daytime or nighttime accidents.

Below are answers to the questions I hear most often.

Q: Which is more effective for constipated children: Ex-Lax or Miralax?

Ex-Lax and Miralax work in completely different ways and have different uses, so you can’t say one is “better” than the other. In some cases, both Ex-Lax and Miralax are needed, either at the same time or at different stages of treatment.

Miralax (PEG 3350) is an osmotic laxative. It draws water into the colon, making stool softer. This helps children who fear pooping because stools are hard or painful.

READ: Why Miralax Clean-outs Fail

Ex-Lax contains senna, a stimulant laxative. Senna stimulates the nerves in the colon and triggers a bowel movement several hours later. For children who tend to hold stool or whose rectal sensation is compromised — in other words, they can’t fully feel the urge to poop because the rectum has become stretched — this strong signal can be very helpful.

Many doctors start with Miralax or alternative osmotic laxatives because osmotics do not cause cramping. But for children constipated enough to develop enuresis or encopresis, simply softening stool typically isn’t enough and can sometimes make matters worse. Softened stool may leak around the hard clog in the rectum, leading to more accidents, not fewer.

In these situations, Ex-Lax is more useful because it creates a strong urge to poop that the child cannot easily ignore. The child will evacuate more fully than with an osmotic laxative alone.

That said, stimulant laxatives may not suffice as a stand-alone treatment. Children with enuresis and/or encopresis typically need a regimen that

1. fully empties the rectum,

2. keeps it empty long enough for normal sensation and tone to return, and

3. retrains the child to respond to the urge to poop.

   
   

In my experience, accomplishing all these often requires enemas, for a period of time, in addition to stimulant and/or osmotic laxatives used at different stages of treatment.

I spell out a variety of combination treatment plans in the M.O.P Anthology.

Q: Is Ex-Lax safe for children?

Many parents are told stimulant laxatives such as Ex-Lax should be taken for no longer than a week because long-term use can cause dependence or damage the colon. The published research does not support these warnings, and I find them greatly exaggerated.

A 2018 review from Nationwide Children’s Hospital examined both the medical literature and the hospital’s own patient records and found no evidence that stimulant laxatives cause tolerance or injury to the colon, even in children who used senna for over a year. One of the paper’s authors, pediatric colorectal specialist Mark Levitt, M.D., told me he still sees no evidence that long-term use of senna is unsafe in children.

READ: Ex-Lax Safety in Children: Are “Toxicity” and “Tolerance” Legit Concerns?

Other review papers, including studies of adults and animals, have likewise found no convincing evidence that stimulant laxatives cause toxic or cancer-causing changes in the bowel.

This doesn’t mean I recommend children take Ex-Lax daily for a year. When a child needs senna that long, it usually means their treatment regimen has not been aggressive enough to fully clear the rectum, and an enema-based regimen, such as the Modified O’Regan Protocol (M.O.P.) is needed.

I frequently see patients who took laxatives for years with little progress, then improved quickly once they started one of the M.O.P. variations.

Q: What is a safe dose of Ex-Lax for children?

Ex-Lax is notoriously under-dosed because parents, understandably, worry about cramping or diarrhea. But some discomfort often comes with the territory. A strong sensation is often exactly what’s needed to trigger a complete bowel movement.

The dose needs to be high enough that the urge to poop occurs within about 5 to 8 hours.

Some children are quite sensitive to senna and will poop fine on one or two chocolate squares; adding or subtracting ½ or even ¼ square can make a big difference. Other children need much higher doses, even up to 6 squares, before they feel the urge to poop. Because children vary so much, dosing usually requires trial and error.

As constipation resolves and the rectum shrinks back to normal size and regains tone and sensation, the child won’t need as much Ex-Lax and will gradually taper off. The M.O.P. Anthology includes a 4-week Senna Taper Plan.

Q: Does Ex-Lax cause dependence?

Many parents worry that if their child takes senna regularly, the colon will “forget how to poop” or develop “lazy bowel.” Many doctors reinforce this worry. I understand the concern, but in my experience this is not what actually happens.

Remember, children who need Ex-Lax in the first place already cannot poop normally. Chronic constipation causes the rectum to stretch and lose sensation and tone. So, the child may not feel the urge to poop at all or may not be able to empty the rectum completely. In this scenario, stimulant laxatives don’t create dependence — they temporarily do the job the rectum cannot do on its own.

When constipation is treated aggressively enough for the rectum to heal, children no longer need Ex-Lax. My patients taper off stimulant laxatives without difficulty.

If a child appears to need Ex-Lax indefinitely, that usually means the underlying constipation has not been fully resolved and the treatment plan needs to be more aggressive.

Q: If a child is too fearful to try enemas, is Ex-Lax an effective alternative?

Sometimes. When enemas truly are not an option, Ex-Lax is the next best tool and is usually more effective than Miralax alone.

Still, enemas typically do a better job than any laxative at fully emptying the rectum, and complete emptying is the key to resolving enuresis and encopresis. For many children in the early stages of treatment, a daily enema plus daily senna (the M.O.P.x regimen) works even better.

To make a real dent in the stool pile-up that’s causing accidents, many children need to poop twice a day. Ex-Lax can’t be used twice daily (you need to take the full dose at one time), so enemas may be needed.

I urge parents not to give up on enema too quickly. Our Enema Rescue Guide, included in the M.O.P. Anthology, includes 12 strategies for helping children overcome apprehension about enemas. Parents are often surprised that enemas become quickly become routine. Many children prefer enemas to Ex-Lax because they don’t have to deal with nausea or cramping.

Plus, pooping is more predictable: with enemas, the urge to poop kicks in right away, rather than several hours later.

Some children are able to resolve enuresis or encopresis on Ex-Lax alone, but many continue to have accidents — or relapse later — because the rectum was not fully cleared out.

Families often start with laxatives only because this approach seems gentler or less invasive than a regimen such as M.O.P. In my clinical experience, this approach typically prolongs treatment. I regularly see children who have taken laxatives for years with little progress before finally trying enemas. Parents say, “I wish we’d have done enemas from the start.”

Q: How long does Ex-Lax take to kick in?

Dosed properly, Ex-Lax should work within about 5 to 8 hours, but that range is wide enough to make timing tricky. The strong urge to poop might strike when your child is at home — or when they’re at school, at soccer practice, or in the car. Because of this, finding the right schedule takes some experimenting.

I suggest trying stimulant laxatives on weekends first. Once you see how long they take to work for your child, you can adjust the schedule so the urge to poop happens at a more convenient time of day.

I recommend children take Ex-Lax earlier in the day rather than at bedtime, so the child is awake when the urge strikes.

Q: If my child doesn’t like chocolate Ex-Lax squares, are there alternatives?

Yes. Chocolate Ex-Lax (or generic) squares are the most common form, but senna is also available in pills, chewable tablets, liquids, and gummies. Some children get tired of chocolate after a while.

Other stimulant laxatives besides senna are also available. Bisacodyl and sodium picosulphate, commonly used outside the United States, have the same effect as Ex-Lax.