Educate me about Miralax & other stool softeners

[longtallsally05]

Update in post #14!

I need some guidance on stool softeners. What kind, how much, how do you get them to take it, etc.

My four year-old DS refuses to poop in the toilet unless he's under great duress. He witholds poop for up to a week, then hides behind a door or in the bushes and poops in his underwear. Obviously, he's constipated. The last couple of loads we've emptied out of his undies have plugged the toilet when flushed. He's pee-trained, but wants to wear a diaper (pull-up) for poop. We hadn't pushed DS, but DH and I drew a line in the sand when DS turned four: pull-ups only for sleeping at night. DD went through similar witholding behavior, but she was poop-trained before she was four. I couldn't get her to drink Colace for the life of me. I'd like to skip the glycerin suppositories, if possible, because the invasive nature of suppositories terrifies my kids and makes them withold even longer (crazy, but true). It's time for stool softeners, scheduled potty times, and more fiber & water. Please share some details of how you have used stool softeners effectively in the potty training of a child who witholds poop. I'm getting desperate here. TIA!

[gatorsmom]

If you do a search you will find some previous threads where parents have outlined their strategies for dealing with this. I'd look now for you but I'm in the middle of soemthing else before I go to bed. I just wanted to make sure someone repsonsed to your post.

I'll try to find some of the more helpful threads tomorrow for you if you'd like.

[karstmama]

i got 'it's no accident' and followed the miralax clean-out suggested, then started on one capful a day. he didn't mind it in water, but i bet it would hide really well in juice. anyway, after a couple of days, he was runny, so i dropped down to 1/2 capful. still runny, down to 1/4 capful & there we stayed for about 3 months. (it would have been longer, but he had other issues come up...)

[WatchingThemGrow]

Well, we are coming down (I hope) from a 3 month bout of constipation where DS2 was completely clogged little squirts sneaking out up to 8x/day. His was pretty severe because we moved 4x in 4 mos during PTing and we didn't realize he was withholding for a month or two. An x-ray revealed the extent of his colon/rectum stretching (dilated 6cm!!!) due to withholding. We'd been doing smaller cleanouts (3-5 capfuls) but last week a specialist put him on an 8 dose cleanout with 1/2 chocolate ex-lax for 3 days, which shocked us. But, he pooped like a champ for days. (Looked like a gas station bathroom in there.) She told us to give him 1 capful to put him on the potty after every meal. He takes his in Gatorade (hates juice) and actually does go 3x/day. It's coming out soft and hopefully his little body is on the way to recovery. He is 3.75. We give him a "Baseball guy (http://www.amazon.com/Baseball-Guys-Kaskey-Kids-Blue/dp/B000GDGWX0)" after each potty trip, which he loves. (I got them at a consignment sale for $6, so not too pricey.)

Our ped said not to be stressed about it because it's going to be a long road to travel, and that he'll likely be on Miralax for 6mos and maybe up to a year as his insides shrink back down to a normal size. The specialist said we're looking for mashed-potato consistency for a long time to give his body time to heal. Hope that's helpful and not entirely TMI.

[Sweetsunshine]

Poor kid! My DD has chronic constipation because she's such a poor eater, not from withholding, but the problem sounds similar to what we go through. I give her 2/3 a capful of Miralax once a day for three months. She's 5 and weighs 36 lbs to give you an idea for dosage. It usually takes about 12 hours to take effect.

Our ped said don't stop just because she has a week or so of soft stool. You really need a few months to totally clean out the system. It will probably take a little trial and error to get the dosage right. Too much and it's runny. Not enough and it doesn't come out. Good luck!

[truly scrumptious]

BTW just wanted to throw this out there. After DD was born I talked to my doc about wanting a stool softener (for myself) and she suggested two teaspoons of almond oil with a glass of milk every night. I tried it and it worked well for me. Just in case you want to look into other alternatives for your DS.
Good luck!

[gatorsmom]

Well, we are coming down (I hope) from a 3 month bout of constipation where DS2 was completely clogged little squirts sneaking out up to 8x/day. His was pretty severe because we moved 4x in 4 mos during PTing and we didn't realize he was withholding for a month or two. An x-ray revealed the extent of his colon/rectum stretching (dilated 6cm!!!) due to withholding. We'd been doing smaller cleanouts (3-5 capfuls) but last week a specialist put him on an 8 dose cleanout with 1/2 chocolate ex-lax for 3 days, which shocked us. But, he pooped like a champ for days. (Looked like a gas station bathroom in there.) She told us to give him 1 capful to put him on the potty after every meal. He takes his in Gatorade (hates juice) and actually does go 3x/day. It's coming out soft and hopefully his little body is on the way to recovery. He is 3.75. We give him a "Baseball guy (http://www.amazon.com/Baseball-Guys-Kaskey-Kids-Blue/dp/B000GDGWX0)" after each potty trip, which he loves. (I got them at a consignment sale for $6, so not too pricey.)

Our ped said not to be stressed about it because it's going to be a long road to travel, and that he'll likely be on Miralax for 6mos and maybe up to a year as his insides shrink back down to a normal size. The specialist said we're looking for mashed-potato consistency for a long time to give his body time to heal. Hope that's helpful and not entirely TMI.

Question for you- do you give him a capful of mirala with each meal to get him to go 3 times per day? How long did your ped suggest you do this for?

I am still having a hard time with greenbean and think I might need to go this route.

[barkley1]

We use milk of magnesia. It's a gentle stimulant (well, it says stimulant free, but that's basically how it works) instead of a stool softener. I had read some iffy things about the ingredients in miralax, so unless it gets REALLY bad, I'm more comfortable using that for now. DS withheld after he was pee trained for some reason so we used it then. Recently, we realized he hadn't pooped in a week, so we started back. He just doesn't listen to his body, and doesn't want to stop playing Long enough to poop. So, now he takes the MoM before bed if he didnt poop that day, and I aske him at least twice a day to sit on the potty and try to go. That, along with drinking more water, seems to have helped.

[WatchingThemGrow]

not sure why it won't quote lisa, but to answer your question...no, only one capful in the morning. The "after every meal" thing is just training him to go on the potty since the "something in/something out" rule makes sense. The specialist said it's the most natural time to go.
Do you think he's really clogged up and needs a cleanout?

[gatorsmom]

not sure why it won't quote lisa, but to answer your question...no, only one capful in the morning. The "after every meal" thing is just training him to go on the potty since the "something in/something out" rule makes sense. The specialist said it's the most natural time to go.
Do you think he's really clogged up and needs a cleanout?

You know, I did a clean out back n November and after being completely cleaned out, like enough to have a colonoscopy, it took a while for my body to go back to normal. I felt like it really disrupted my digestive system. So I've avoided doing such a severe clean out with Greenbean. The ped said I could give one capful of miralax 3 times per day for three days. I tried 2 per day but his poop was too runny. So I modified it to one and a half capfuls per day. I want to find the right balance to make sure his poop is very soft but not runny so that he gets in the habit of going every day but doesn't have diarrhea accidents.

[123LuckyMom]

Our ped told us to give 1/2 capful to a whole capful of Miralax daily plus a tablespoon of mineral oil twice a day. We did no clean out.

We purchased orange juice specifically to mix with the mineral oil. DS loved it! He drank some with breakfast and some with dinner. The Miralax we mixed in his yogurt or a premixed chocolate milk, again purchased just for this. The horizon chocolate milk seemed to accept the Miralax where plain milk didn't. He took that in the morning. He also had set times every day where he had to sit on the potty to try to poop.

After he was pooping regularly, I dropped the mineral oil. We only used that for about a month, maybe less. We used a capful a day of Miralax for four months, I think, and weaned him off rather than stopping cold turkey.

Now his poops are fine, but he will sometimes neglect to listen to his body and will go a couple of days without ever sitting (because he pees standing up). If I notice he's on the second day, I make sure he sits at the last potty visit before bedtime. That does the trick.

[Hawkeyewife]

Personally, I would stay away from laxatives and mineral oil. Most laxatives prescribed to children do their job by helping the body retain water and soften the stool that way and mineral oil will make things slicker but also can block nutrients from being absorbed through the intestine. I would start with looking at your little one's diet. If it is basically "white" you need to add some color (in terms of fiber). Some kid friendly fiber foods are apples, pears, sweet potato fries, carrots, strawberries, popcorn etc... You may want to consider limiting or eliminating dairy products for a while (especially cheese) and adding a probiotic to your little one's diet. You can also try adding a tablespoon or two of prune juice daily in your child's milk or yogurt etc.

I would also try adding a cup of epsom salts in the bath and making sure there is a good stool for your little one to put his feet on when bearing down to poop, dangling feet make it more difficult to eliminate.

Little ones should poop everyday and it is not unusual to have a bowel movement more than once a day. Withholding for days/weeks/months is not healthy. Being on laxatives for weeks/months is also not healthy as becoming dependent upon them can lead to muscle weakness and loss of peristalsis.

Good Luck! My youngest (3 and a half) also withholds and we have been working for months on encouraging daily BMs.

[gatorsmom]

Personally, I would stay away from laxatives and mineral oil. Most laxatives prescribed to children do their job by helping the body retain water and soften the stool that way and mineral oil will make things slicker but also can block nutrients from being absorbed through the intestine. I would start with looking at your little one's diet. If it is basically "white" you need to add some color (in terms of fiber). Some kid friendly fiber foods are apples, pears, sweet potato fries, carrots, strawberries, popcorn etc... You may want to consider limiting or eliminating dairy products for a while (especially cheese) and adding a probiotic to your little one's diet. You can also try adding a tablespoon or two of prune juice daily in your child's milk or yogurt etc.

I would also try adding a cup of epsom salts in the bath and making sure there is a good stool for your little one to put his feet on when bearing down to poop, dangling feet make it more difficult to eliminate.

Little ones should poop everyday and it is not unusual to have a bowel movement more than once a day. Withholding for days/weeks/months is not healthy. Being on laxatives for weeks/months is also not healthy as becoming dependent upon them can lead to muscle weakness and loss of peristalsis.

Good Luck! My youngest (3 and a half) also withholds and we have been working for months on encouraging daily BMs.

I agree that other solutions should be tried first before jumping to laxatives. When Greenbean started first basic solids foods with breast milk, he was straining and screaming. So the second food we gave him was prunes. As we introduced more foods we continued to give prunes and more fruit juice. We were givning him more prunes and fruits than any other food at one point! And it started not to work. Greenbean eats plenty of fruit and yogurt throughout the day. He naturally avoids binding foods. There is no way that on his own he will be able to pass that stool. I think there are a lot of kids at this age who refuse to poop because they are playing and hold in the stool enough to start a vicious cycle of hard stool, pain and more not pooping. For those kids who tend to avoid pooping, miralax can prevent a lot of pain and regression in their potty training. I try not to discourage it when it really can help in those difficult situations.

[longtallsally05]

Update: DS poops in the potty! Thanks for your help, BBBers! Maybe it's TMI (is there such a thing on the BBB?) but below I've summarized the process.

I should have mentioned in the original post that I was already on the bandwagon re: diet & putting a step stool under DS's (but he'd kick it away in a fit of fury). DS would pee in the potty just fine, but he was terrified of pooping in the potty. In fact, DS was pooping in his pull up every day (never peed the pull up) until I pulled the trigger & put him in underpants. As soon as he knew it was time to poop in the potty, he started withholding. He would hold a week or so and then hide somewhere & poop his pants. We were on "DS watch" constantly, and it was frustrating for all of us. DS held it so long that it was painful for him to poop (there would be blood on the tissue when you wiped), and he would cry & tantrum. It had become a vicious cycle because the longer he'd wait, the worse it got, reinforcing his fears. I thought we had broken through the barrier when we started bribing DS with Matchbox cars for poops. DS began pooping regularly for cars, but after we phased those out he went right back to withholding.

DS already loves carrots & broccoli (eats them daily), and he also eats apples, grapes, strawberries etc and he loves yogurt. I did reduce the amount of cheese he was eating & tried to get him to drink more water. After reading up on MiraLax, I decided to give DS 2 tsp mixed with chocolate milk (which he loves but it's a rare treat in our house) once a day, and after a day and a half he just couldn't hold it in anymore. I gave him 2 tsp a day for a couple of weeks and started getting over his fear & reluctance. After many massive poops, once his his stool was soft & regular in frequency & amount, I backed down to 1 tsp a day, and now I'm backing it down to 1/2 tsp every day. DS will now decide on his own to poop (hooray!). Sometimes he needs an audience & fanfare (& a reward of jelly beans) other times he wants privacy, wipes his own tush & forgets to ask for a reward. DS is proud of his success, and so are we! DS even pooped in the potty at a restaurant the other night & announced it loudly upon exiting the restroom, to the servers' great amusement. DS often comments on how DS2 is still a baby because he poops in his diapers, lol. I'll continue to step down the MiraLax until we've completely phased it out. I hope this time the potty habit is well-ingrained. I only wish I'd tried MiraLax on DD, who was terribly constipated due to withholding & who plugged our toilets with her constipated stool for months. I'm so very glad we've only had to plunge a few times with DS!

Thanks again for sharing your stories & knowledge. It's always nice to make a connection on the BBB because I know I'm not the only one who is experiencing something. Being a military family, we move frequently & I'm always rebuilding my IRL network of mom friends. I'm glad I found the BBB before DD was born in '06. I may not get here as often as I used to, but I'm always glad when I have a moment to check in!

[Sweetsunshine]

Glad to hear it went so well. He must feel so much better. Thanks for,the update!

[gatorsmom]

So happy to hear your success story!!