Miralax, Magnesium Citrate, Enemas, and Suppositories: Your Questions Answered
- Steve Hodges, M.D.
- Apr 27, 2017
- 4 min read
Updated: Jan 14
By Steve Hodges, M.D.
Editor’s note: This article was updated in 2026 to reflect Dr. Hodges’ current treatment recommendations.
I get questions every day about children’s laxatives, enemas, and suppositories. With so many products on the market, it’s no wonder parents feel confused about what does what —and which options actually help resolve bedwetting and daytime accidents.
Below are answers to questions I hear often from families in clinic and in our private support group.
Q: Our pediatrician said Miralax is not effective when mixed in milk — that it must be mixed with clear liquid such as water or juice. Is this true?
A: Miralax works fine in milk. Just do some extra mixing, because the powder doesn’t dissolve as easily in milk as it does in clear liquids. I have patients who will only drink Miralax in milk, and that’s not a problem.
Miralax keeps poop soft for children with mild constipation, but just keep in mind it's not effective as a stand-alone treatment for enuresis (daytime or nighttime wetting) or encopresis (chronic poop accidents). When the rectum is clogged enough to trigger accidents, children require more robust treatment, such as the Modified O'Regan Protocol (M.O.P.).
Q: How does magnesium citrate compare to Miralax as a stool softener?
Magnesium citrate is popular among parents who are not comfortable giving their children Miralax (PEG 3350), and for many kids, it does the job.
Just know that some magnesium citrate products are not intended as a laxative but rather as a “relaxation supplement.” So, the bottle's recommended dose may be lower than what your child needs for help pooping. Unlike with PEG 3350, dosages to treat constipation with magnesium citrate are not well-established, so you’ll need to experiment.
The powder version, such as Natural Calm, is the most popular, but some kids find the taste sour and won't drink it in the quantity needed to soften stool. Magnesium citrate is also available in liquid, gummy, or tablet form.
An effective alternative to both Miralax and magnesium citrate is lactulose, a sweet-tasting, low-cost prescription liquid that's easy to administer and that kids tend to tolerate well. Another option is magnesium hydroxide, also known as milk of magnesia. It’s the active ingredient in Pedia-Lax Chewable Saline Laxative tablets.
In the M.O.P. Anthology, my treatment manual for enuresis and encopresis, I discuss dosing for all four of these laxatives and how osmotic laxatives fit into the larger treatment picture.
Q: What's the difference between an enema, a liquid glycerin suppository, and a solid glycerin suppository? Which is the most effective?
A: An enema is the general term for a treatment to stimulate a bowel movement by squeezing fluid into the rectum via a flexible plastic tube or syringe. Enemas typically prompt the child to poop within 5 or 10 minutes.
A liquid glycerin suppository (LGS) is simply one type of enema — the liquid is glycerin. Another option is a phosphate enema, described on the box as a "saline laxative enema" (though the active ingredient is phosphate). Yet another enema solution is docusate sodium, used in the Enemeez brand of mini-enemas.
All three types of enemas come in two sizes, based on the child's age.
A huge benefit of liquid glycerin enemas is that you can make them cheaply at home, with just a bottle of glycerin and a syringe. (See page 100 of the M.O.P. Anthology for DIY instructions).
You cannot make your own phosphate or docusate sodium enemas, as these products contain additional necessary ingredients.
I recommend experimenting with different enema types. You can't predict which will work best for a given child. Some children experience a burning sensation with phosphate, in which case I recommend glycerin or Enemeez. In some cases, I recommend alternating enema types, as I explain in the Anthology.
Though many doctors today disparage enemas as "traumatic" for children or "overly aggressive," I find that my patients tolerate them very well. Enemas are as old as medicine. In fact, the procedure is referenced in the Ancient Egyptian Ebers Papyrus and was touted by Hippocrates himself circa 400 B.C.E.
It's clear enemas are safe for children, and as a treatment for enuresis and encopresis, enemas are far more effective than oral laxatives
As for glycerin suppositories, these bullet-shaped gels tend to be less effective than the liquid variety and less reliable — sometimes they get “spit” right out of the child’s bottom. However, they are a good alternative for children under age 2, who are too young for enemas, and sometimes work for older children as well.
Q: My 5-1/2-year-old has daytime and nighttime wetting and says her tummy hurts. She poops normally — at least every couple of days. Her doctor felt her tummy, said she’s not constipated, and implied she’s complaining for attention. The doctor won’t order an x-ray “due to the risk of radiation on her ovaries” and has prescribed a daily laxative to appease us. Will that be enough?
A: Highly unlikely. Let’s clear up a few misconceptions. First, pooping every couple of days isn't normal. As I tell my patients, anyone who eats every day should poop every day. Otherwise, stool starts to pile up in the rectum — hence the tummy aches.
Second, you can't detect constipation simply by feeling a child's belly. The rectum stretches to accommodate an accumulation of stool, and even a small, wiry child can harbor a hard mass of stool without it being palpable.
X-rays are safe, as I explain in the Anthology, and far more accurate than other methods of detecting constipation.
Daytime and nighttime wetting are red flags for significant constipation, and a daily laxative is unlikely to resolve the accidents. A daily enema regimen such as M.O.P. will do a much better job of dislodging the mass of stool that is stretching your daughter's rectum and aggravating her bladder nerves.