Dear Dr. Hodges,
I am thinking of starting my daughter on the mega-dose of MiraLAX you recommend in your book but am nervous we’re going to be in for a mess! Is it possible to resolve constipation with a lower dose used over a long period of time?
Fearful Mom in D.C.
Dear Fearful Mom,
I hear this concern all the time. I understand that the huge doses of MiraLAX I recommend can be intimidating to parents or seem like overkill, especially to parents who think their kids are pooping fine.
But I can’t stress this enough: The kids who do best on our program are the ones whose parents are most aggressive with the bowel program.
When your child has a mass of poop stuck in her rectum, tentative measures simply won’t cut it. (And frankly, enemas are the way to go, as I explain in this post, “Yes, Enemas Are Safe for Children, and They Work Better Than MiraLAX.“)
In addition to fearing the mess of a MiraLAX washout, many parents worry their children will become so used to the laxatives that they can’t poop without them. Also, many parents refuse to use MiraLAX altogether because they believe it isn’t a “natural” way to encourage regular bowel movements.
All three fears are unfounded. I’ll explain why. (I address the safety of MiraLAX in "Is Miralax Toxic for Children?")
For one thing, we are not treating constipation as it’s usually defined (rare or hard bowel movements). I repeat: We are NOT treating constipation. What we are trying to do is restore rectal tone.
We are trying to take a tube in the body that has been stretched out to 8 to 10 centimeters in diameter and bring it back to its original size of about 2 centimeters in diameter. (Here is where X-rays are really useful in showing parents how bad the problem really is.)
You can accomplish this shrinkage only by first dislodging the clog and then emptying the colon regularly so that it regains its tone. A few doses of MiraLAX won’t break apart a solid mass that has been irritating your child’s bladder for months or years. In fact, don’t be surprised if it takes multiple mega-clean-outs to get your daughter’s colon unblocked.
So, yes, it’s likely to be a mess, but that’s a small price to pay. If you are worried about how your daughter will react, know that most kids are so happy to find relief that they don’t complain.
Know, too, that some kids are so clogged up that the MiraLAX washout doesn’t work. The laxative may cause such a rapid rush of liquid out the rectum that it simply bypasses the hard poop mass, leaving the lump intact. Because of the mess, parents may stop short of the full clean-out process and assume prematurely that the child’s colon is clear.
In these cases, parents may need to use daily enemas. Honestly, if every family would agree to the enema regimen, that would be my first choice for severely constipated children.
Are laxatives habit forming? Osmotic laxatives, such as MiraLAX or generic versions, are not. These over-the-counter powders merely draw water into the colon so the poop stays soft. The key ingredient is PEG 3350, polyethylene glycol, which is safe for long-term use — yes, even in babies — as I explain in great detail in the book.
Stimulant laxatives such as Ex-Lax can be habit forming in high doses over extended periods, but when a child’s rectum has been stretched over a period of years, these may be necessary for a few months to restore normal bowel motility. An experienced pediatric gastroenterologist will make sure your child does not take too much of this medication or take it for too long.
As for the notion that using laxatives isn’t natural, my response is this: Carrying a colon full of poop throughout a kid’s entire childhood, a common scenario these days, is not natural either.
Raisins, prunes, fresh veggies are all well and good — I absolutely encourage a high-fiber, whole-foods diet.
But the time for high-fiber diets is before toileting problems develop or after they’ve been treated, to keep things moving. In a child with stool backup that has been accumulating for years, that’s spitting in the wind.
Bedwetting and Accidents Aren’t Your Fault is a helpful starting point for any family about to embark on the MiraLAX cleanout or enema regimen. Read the book with your child, and I think both of you will find yourselves feeling more confident about what to expect.