Yes, Enemas are Safe for Children — and They Work Better Than Miralax

By Steve Hodges, M.D.

When kids are chronically constipated, it takes more than a stool softener to break up the blockage.

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

If there’s one word parents don’t want to hear in the doctor's office, it’s enema.

So when I explain to folks that enemas are what it takes to stop bedwetting, daytime accidents, and poop accidents for good, I tend to hear the same three questions:

1. Aren’t enemas dangerous for children?

2. Can’t we just try Miralax first?

3. There’s no way my child will agree to this. Then what?

Let’s take these concerns one at a time.

1) Aren’t enemas dangerous for children?

Nope. For healthy children, there’s no evidence enemas are risky—let alone dangerous—and decades of research and clinical experience show they are well tolerated.

The most common concern I hear from parents is electrolyte imbalance. But this issue applies only to enemas (such Fleet “saline laxative enemas”) that contain phosphate, which is just one of several enema solutions.

If you—or your doctor—are concerned about electrolyte imbalance, simply avoid phosphate enemas. As I explain in the M.O.P. Anthology. there are multiple highly effective alternatives, such as glycerin and docusate sodium,

For context, phosphate is an electrolyte that helps regulate nerve and muscle function, hydration, and blood pressure—and yes, an imbalance would be a big deal. But the body is very good at maintaining balance. In a child with normal kidney function, excess phosphate is simply excreted in the urine.

Research shows the risk of using phosphate enemas in children is extremely low. A review of 39 studies over 50 years found just 15 cases of electrolyte imbalance in children ages 3 to 18—almost all involving children who had underlying medical conditions or were given more than one phosphate enema per day. I’ve never had a patient develop an electrolyte imbalance from a regimen of daily phosphate enemas.

That said, phosphate enemas aren’t my go-to enema these days. Phosphate enemas must be purchased (you can't recreate the solution at home), and are limited to once-daily use; also, in a minority of children, the solution causes a burning sensation. On the other hand, glycerin enemas can be made inexpensively at home, are gentle for most kids, and can be used more twice a day if needed. (Yes, some kids need two daily enemas at first.)

What about the risk that enemas will lead to dependence” or a “lazy bowel”?

This is another common concern, but it’s unwarranted and based on a misunderstanding.

In a constipated child, the bowel is already not functioning normally. Over time, the rectum becomes stretched and loses the sensation and tone needed for normal emptying. The goal of treatment is to restore that function so the child can feel the urge to poop and respond to it.

Early in treatment, many children don’t poop on their own except after an enema, a scenario that alarms some parents. But that’s not dependence—it’s a sign the rectum hasn’t yet recovered.

Dependence means something very different. A child with type 1 diabetes will always depend on insulin. A child following a structured treatment plan like the Modified O’Regan Protocol (M.O.P.) will successfully taper off enemas once the rectum has healed and accidents stop.

In the meantime, if enemas are what it takes for your child to fully evacuate every day, that’s a good thing—because fully emptying the rectum is a lot healthier than not emptying it.

2) Can’t we just try Miralax first?

You can. Many families do—for years and years.

The thing is, Miralax often doesn’t fully empty the rectum. It softens stool—but softer poop doesn’t necessarily result in complete evacuation. New stool can ooze around the hard, dry mass, leaving the rectum stretched and continuing to interfere with bladder and bowel function.

Even when Miralax reduces accidents, the effect is often short-lived. Many children end up on the “Miralax merry-go-round” indefinitely.

READ: Getting Your Constipated Child Off the Miralax Merry-Go-Round

Enema-based regimens outperform oral laxatives alone, especially in children with a long history of frequent pee or poop accidents.

This isn’t just my opinion. It’s what the data show:

• In a three-month study from my clinic, 85% of children using an enema-based regimen stopped daytime wetting, compared to 30% who used Miralax but not enemas.

• In a Dutch study of 90 children with fecal impaction, those treated with enemas had higher rates of successful clean-out and dramatically fewer ongoing poop accidents in the post-treatment period than those treated with high-dose Miralax.

• In a study of children with severe encopresis (averaging 13 accidents per week), an enema-based regimen reduced accidents to near zero. Researchers described the regimen as “highly effective,” “rapid,” and “low-risk.”

The takeaway isn’t that Miralax never works. It’s that for children constipated enough to have frequent accidents, it’s usually not enough to fix the underlying problem.

READ: Children with Encopresis and Enuresis Deserve the Best Treatment, But Most Aren't Getting It 

Stimulant laxatives such as senna (Ex-Lax) tend to be more effective than osmotic laxatives like Miralax. (See “Should I Give Ex-Lax to My Constipated Child?”) But even Ex-Lax—alone or combined with Miralax—falls short for many children. and often just creates a mess.

Doctors often recommend laxatives over enemas because they're "less invasive" and seem “easier." But in my 20+ years of experience, what’s actually easier for children is life without accidents—and that outcome far more likely when the rectum is fully emptied.

3) There’s no way my child will agree to enemas. Then what?

That’s what most parents assume, and doctors often reinforce this worry by warning that enemas are “traumatic” for children.

In my experience, this concern doesn’t match reality.

Children with enuresis or encopresis are often far more distressed by their symptoms than they let on to their parents. Many avoid sleepovers, fear they “smell,” and quietly withdraw from peers. When parents explain that enemas will help them feel better and stop accidents faster than laxatives, most children are willing to give it a try.

In my experience, doctors who label enemas “traumatic” have no firsthand experience with a regimen such as M.O.P. and simply are making assumptions.

The key to gaining a child’s buy-in is to present the plan with confidence. When parents feel fearful or skeptical, kids sense that. But when parents present enemas as a normal, temporary, medically-necessary step toward resolving enuresis or encopresis, kids tend to adapt.

One mom in our private support group, who's also a counselor in a constipation clinic, explains it this way: "Children’s compliance with [enema] treatment is greatly impacted by the attitude of others around them. Everyone needs to be paddling in the same direction, so to speak. Kids pick up on adult emotions. In some cases, parents are refusing to participate, so it's no wonder the child doesn’t feel great about it. Once parents feel good about the treatment, kids start to cooperate."

Most families I work with conclude that enemas are far less traumatic than the alternatives. As one mom in our support group posted:

“It is way more traumatic to poop in the middle of class and stink up a room full of kids who don’t yet have a verbal filter. A quick, painless enema is much easier. My daughter asks for enemas now and has so much more confidence. She used to whisper to me, ‘Do I smell?’ That broke my heart. That was traumatic.”

That said, it’s completely normal to feel apprehensive at first. Most fears come down to one concern: Will it hurt?

Sometimes it does—but usually for fixable reasons: the child is tense, the positioning is off, or there isn’t enough lubrication. Those details matter. Once they’re dialed in, the process tends to become routine pretty quickly.

The M.O.P. Anthology includes an Enema Rescue Guide with a dozen practical, kid-tested strategies to help families get past that initial hurdle.

Parents also report that our children’s books, Bedwetting and Accidents Aren’t Your Fault and Emma and the E Club, help kids warm up to the idea of enemas, reassuring them that plenty of other kids need the same treatment.

Enema may be the word parents don’t want to hear—but for many children, it’s the solution that finally works.