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

By Steve Hodges, M.D.

NOTE: This article is excerpted from Helping Your Child Exit the Miralax Merry-Go-Round. Download the complete, 20-page guide here.

I’ve treated enuresis and encopresis for 20+ years, and if there’s a one insight I could share with my younger self, it’s this: Miralax won’t cut it.

In my early years as a pediatric urologist, I treated bedwetting and daytime pee and poop accidents the way I’d been taught: with PEG 3350, the laxative powder sold as Miralax, Restoralax, Osmolax, and generic brands. If a daily capful of Miralax didn’t help, I’d recommend high-dose

Miralax “clean-outs,” followed by a daily “maintenance” dose.

But more often than not, accidents would persist or worsen. Parents would bring their kids back

and ask: “Now what?” I’d offer the only answer I knew, the one most doctors worldwide still offer:

more Miralax. Then more.

That’s how children end up on the Miralax merry-goround,

a slow-moving carousel to nowhere.

I didn’t coin the term — I first heard it from a mom in

our private Facebook support group, whose son had

struggled with encopresis for three years. She wrote:

“Doctors put him on Miralax, but we kept going in a

circle: weaning and then more constipation and more

accidents. After all this time on the Miralax merry-goround,

nothing is changing.” The boy was still in diapers.

That’s a common scenario. I have patients who, prior

to visiting my clinic, were told to undergo Miralax “clean-outs” every month for a year. Or every

weekend for months. I’ve known teens who’d spent an entire decade on Miralax and were still

wetting the bed.

In some respects, “Miralax merry-go-round” is a fitting metaphor. After all, the child is going

in circles, never moving forward. But in other ways, the term is far too rosy. Carousels are fun!

Miralax, taken endlessly and futilely, is not. As one mom in our support group posted:

We did the Miralax merry-go-round with my daughter for about a year. At every

doctor’s visit, they would up the dose until it was 4 caps a day for a 2.5-year-old.

She would withhold withhold withhold, up to a week and a half, and then have

explosive diarrhea that she cried through while clinging to me (poop EVERYWHERE

despite a diaper).

Another mom reported that at age 4, her daughter was having up to 20 poop accidents a

day, causing “ulceration of the skin around her anus.” And yet, she wrote, “For three years, our

pediatrician and pediatric GI specialists did nothing other than recommend more Miralax and

clean-outs, which would help for a couple of days, then she would regress again. I was at the end of my rope. It was so stressful and emotionally draining.”

Parents dutifully follow through because they’re not offered an alternative. “Oral clean-outs

have never really helped us, but we have done them, anyway, to appease our GI,” one mom posted.

Needless to say, appeasing your doctor should not be the goal of treatment! There is a better

way: the Modified O’Regan Protocol (M.O.P.), an enema-based approach that is far more

effective than PEG 3350 alone.

Based on the research of Sean O’Regan, M.D., a pediatric kidney specialist, M.O.P. involves daily enemas (such as glycerin, phosphate, or docusate sodium) for at least 30 days and until accidents stop, at which point the child gradually tapers off enemas. Most M.O.P. variations

include laxatives, too, but as an adjunct to enemas or a later step in treatment, not as a stand-alone starting point. The six M.O.P. variations are spelled out in The M.O.P. Anthology 5th Edition, our comprehensive treatment manual. The book also details the history of Dr. O’Regan’s

regimen, which he devised in the 1980s to treat his own son’s bedwetting. Based on his son’s success, Dr. O’Regan tested the regimen on French Canadian children, publishing multiple groundbreaking studies.

“M.O.P. was the first thing that made sense — and gave me ‘permission’ to do something besides Miralax,” wrote the mom whose 2.5-year-old once took 4 caps of Miralax per day. “It was life changing.” She added: “With most medical issues, if a medication doesn’t work, you try something else. Why is that not the norm with childhood constipation? Especially since an alternative exists.”

This guide isn’t a diatribe against Miralax. I’m not opposed to PEG 3350. I believe it’s safe

for most children, though I take seriously the reports of Miralax-related mood changes and

encourage concerned parents to use alternatives, such as lactulose, magnesium hydroxide, or

magnesium citrate. For many kids, osmotic laxatives can be quite helpful, softening stool so

pooping is easier and less painful. Heck, I gave Miralax to my own children. But my kids didn’t

have enuresis or encopresis. Most children constipated enough to have pee or poop accidents

require far more robust treatment than PEG 3350 alone.

In this guide, I explain why PEG 3350 so often fails and why doctors keep prescribing it, anyway. I cite illuminating studies and offer advice from parents who’ve navigated their child’s transition

from Miralax to M.O.P. I also describe three scenarios where osmotic laxatives such as PEG 3350 are helpful in kids with enuresis or encopresis.

To be sure, M.O.P. is not a bullet train. Setbacks are common, and progress is rarely linear. Your child's ride will have its ups and downs. But remember: Chronic constipation didn't develop overnight. It won't resolve instantly, either, but the M.O.P. approach works.

I’ve never met a parent who said, “I’m so glad my child spent 5 years on Miralax.” But I’ve met

countless folks who wish their child had tried enemas from the get-go. As one mom posted:

We did nearly 4 years of PEG and regular Ex-Lax and clean-outs. When we started

M.O.P., poop accidents stopped immediately, and we’ve gone from almost daily

pee accidents to now dry. If I could go back, I’d do M.O.P. right from the start. My

son no longer has to go through the embarrassment of having wet and dirty pants

and having to discreetly get changed into clean clothes. He finally has his life back.

The complete guide includes these sections:

•Why Miralax Fails

•Why Doctors Push PEG, Anyway

•4 Reasons to Exit the Miralax Merry-Go-Round

•PEG and Enemas: What Studies Reveal

•When Miralax Actually Helps

•Helping Your Child Get on Board

•If Your Doctor of Spouse Oppose Enemas