By Steve Hodges, M.D.
I X-ray all the patients referred to me for bedwetting and daytime accidents. Virtually all of these kids are shown to be severely constipated, with a rectal diameter greater than 3 cm, sometimes as wide as 6 to 8 cm (think: softball). In terms of prior treatment, these kids tend to fall into two categories:
1.) children whose constipation went undiagnosed by their referring doctor, and
2.) children who were prescribed Miralax and, when that failed, more Miralax and then . . . even more Miralax.
Needless to say, all that Miralax — known generically as PEG 3350 and sold in the United Kingdom and Australia as Movicol — did not work. Otherwise, these kids would not have landed in my incontinence clinic!
Much has been written about Miralax safety in children. As I noted in “Is Miralax Poisoning Children?,” I suspect research will not find a link between PEG 3350 and psychiatric symptoms, though I support the ongoing FDA-funded investigation and believe that Miralax may adversely affect a small minority of children.
However, my biggest concern about this powder is that it is way, way over-prescribed.
In my experience, PEG 3350 is neither poison nor panacea. It can be helpful in certain circumstances, and many of my patients take it. But Miralax is inadequate in other situations. And given the range of effective alternatives available, Miralax is not something parents who worry about its safety ever need to give to their children.
In our new downloadable infographic, I spell out what I think is important for parents and medical professionals to know about PEG 3350. Please share it with other parents and with pediatricians, GI doctors, and urologists!
FACT #1: Doctors rely too heavily on Miralax.
Here’s what Miralax achieves: softer poop. PEG 3350 draws water into the colon to keep stool mushy, so pooping is less painful.
Problem is, for severely constipated children, Miralax may not fully break up the large, hard, stool mass that is stretching the rectum and pressing against the bladder. In many cases, softened poop merely oozes around the big mass, solving nothing — and sometimes creating new problems, such as poop accidents.
For children who wet the bed or have daytime accidents, I consider osmotic laxatives — including but not limited to Miralax — an important adjunct to therapy but not a solution.
These children also need more aggressive, bottom-up treatment such as the Modified O'Regan Protocol (M.O.P.), a regimen involving daily enemas or liquid glycerin suppositories. I explain the differences between these products here and describe M.O.P. in The M.O.P. Book.
FACT #2: Enemas resolve wetting far better than MiraLAX.
I used to believe that for treating enuresis (wetting) and encopresis (poop accidents), a high-dose Miralax clean-out followed by a maintenance regimen was nearly as effective as daily enemas. I know longer believe that.
In the 7 years since I wrote It’s No Accident, I’ve gained more experience and conducted research comparing the Miralax and enemas. I have concluded that daily enemas are the key to resolving bedwetting and accidents.
For example, in a 3-month study of 60 children who wet their pants daily, 30% of those treated with standard therapies, including Miralax and in some cases medication, stopped wetting completely. Of those who combined daily enemas with Miralax (following the step-down Modified O’Regan Protocol), 85% stopped wetting.
X-rays explained the difference: After 3 months, the rectums of the enema group had shrunk back to normal, averaging 2.15 cm in diameter. The rectal diameters of the Miralax group remained stretched, to 5 cm on average.
Clearly, enemas do a better job of clearing out the rectum so it can bounce back and stop bothering the bladder.
Though most parents, understandably, don’t like to hear this, some are actually relieved when I tell them, as using high doses of Miralax can be a messy proposition. The families I work with usually come around to trying enemas and are glad they did. Many children find so much relief, from the stomachaches and accidents, that they ask their parents for their nightly enemas. (Don’t believe it? Read "11 Ways to Ease Your Child’s Fear of Enemas.”)
FACT #3: If you worry about PEG 3350 safety, you can use alternatives.
I understand why parents would be reluctant to give their children Miralax, but this isn’t an issue that should weigh heavily on them. If you worry the stuff isn’t safe, use an alternative!
There are plenty of effective osmotic laxatives that carry no baggage related to safety. These products include:
•Magnesium citrate powder (such as Natural Vitality’s Natural Calm) or tablets
•Lactulose (a prescription liquid)
•Magnesium hydroxide chews (such as Pedia-Lax Saline Laxative Chewable Tablets)
The parents in our private Facebook support group are constantly swapping ideas for alternatives, since children have varying preferences for taste and consistency, and for some kids, certain laxatives just work better than others. You can read a range of parent viewpoints in our ebook "Answers to 52 Questions About M.O.P." Even if you're not concerned about the safety of Miralax, it may be worth experimenting with other options.
FACT #4: MiraLAX is not a lifetime solution to constipation.
Once constipation resolves, children should stay on osmotic laxatives for 3 to 6 months, possibly a lot longer. The holding habit dies hard and children can relapse if families don’t remain vigilant. But that doesn’t mean a child should take laxatives forever. Hardly. To keep constipation at bay, kids should:
•Eat “real” rather than highly processed food
•Drink plenty of water
•Poop with feet planted on a tall stool
OK, now go download our infographic and share it!