Ahh MiraLax. Doctors love it. Parents love it but only every now and then. Or they hate it because they don’t think it works. Or they know it works but they hate the thought of their kids being on a laxative. Kids are usually OK with taking MiraLax. But parents … Parents take some convincing.
But here’s the thing: If you were researching how to manage constipation in kids back in the 80s or 90s, you would have found several studies reporting that laxative use alone is not effective at treating childhood constipation in the long-term. When treated with lactulose or mineral oil, even for months, kids didn’t get to a point where their constipation resolved.
All that changed in the late 90s, early 2000s, when doctors began prescribing polyethylene glycol, or MiraLax, for kids.
MiraLax, or polyethylene glycol, is an osmotic laxative, which means it draws water into the intestine and softens the stool. Kids don’t mind it as much as other laxatives, because it is mostly tasteless and doesn’t cause cramping. Doctors like it because it’s easy to dose, it doesn’t lose its efficacy with long-term use, and it doesn’t get into the bloodstream and have an effect on other bodily systems.
(The Internet, of course, is full of claims that MiraLax causes neurological problems, but these have not been found in actual studies. Here is a summary from Children’s Hospital of Philadelphia of the research on MiraLax.)
So MiraLax seems to be an effective way to manage constipation in kids. The problem, of course, is when it’s not.
If you’ve read The Constipation Game Plan, you know that I strongly endorse the use of laxatives to treat constipation. I think of the GI tract of a chronically constipated kid as injured, and laxatives are a key component of letting the colon and rectum heal. (I explain this in much greater detail in the book.) But laxatives alone don’t work for most of the kids I treat, despite the research that says they should. I have a few theories as to why:
- Many doctors don’t prescribe a disimpaction, or clean-out, before starting a daily dose. The large majority of my patients have been prescribed a daily MiraLax dose, but that newly-softened stool just goes around the back-up of stool that is hanging out in the colon and rectum. The MiraLax might get these kids to poop a little bit every day, but it doesn’t help the system get back to working on its own like it should.
- Compliance in taking a daily dose, and repeating a clean-out if symptoms return, is poor. The researchers studying the efficacy of MiraLax closely monitored that the laxative was taken daily at the correct dose. Most of the kids I work with have been told to take MiraLax whenever they feel they need it, but inconsistent use doesn’t allow the colon to heal.
- The laxatives aren’t used for a long enough duration. Parents and kids are (understandably) eager to stop using laxatives as soon as symptoms improve. But for the colon and rectum to heal and start functioning like normal again, they need poop to be super soft for a pretty long time. (How long is up for debate, but most GI docs I’ve spoken to or read will say at least a year, and often multiple years.)
So, if they are used exactly as prescribed (and if they are prescribed appropriately), laxatives can help most kids recover from chronic constipation. But nobody wants their kid to be on MiraLax for years! Trust me, I don’t. That’s why I wrote The Constipation Game Plan.
The way I see it, you have two ways to help someone recover from chronic constipation. You can set them up on MiraLax for years, diligently taking a daily dose and doing periodic clean-outs whenever they have any signs of getting backed up.
Or, you can set them up on a prescribed laxative, and then give them other tools to help them get back on track, heal up, and get off long-term laxative use. I’ve researched almost everything when it comes to constipation management in kids, and the most effective treatments combine laxatives (and sometimes enemas), behavioral changes, changes in posture on the toilet, and exercises.
The Constipation Game Plan is your toolbox: how to set up a toileting schedule, how to sit on the toilet, what dietary modifications work (hint: it’s not adding more fiber), and what professionals to call when you need more help. It takes a lot of vigilance, but even the toughest cases of chronic constipation can be alleviated with a multi-pronged approach.
So if you’ve got a kid with chronic constipation (in your family, in your classroom, or in your clinic), tell them not to give up on using MiraLax or whatever other laxative has been prescribed. But read The Constipation Game Plan so you can help them maximize the effectiveness of laxatives and get them back on a healthy GI track.
P.S. If you feel like your child could use some more aggressive management of constipation, I highly recommend you bring the clinical pathway for chronic constipation from Children’s Hospital Colorado to your next visit with your primary care provider. You and your provider can identify where your child is on the pathway and figure out a plan for laxative use that hopefully will lead to long-term improvement.