On Friday May 25th an article appeared in the New York Times titled Drug For Adults is Popular as Children’s Remedy. It addresses the widespread prescription by pediatricians and GI specialists of Miralax, a colorless odorless liquid laxative for long term treatment of constipation in children, despite the fact that it has never been approved by the FDA for long term use in anyone, and not at all for use in children. The FDA has approved the use of this drug for adults, and for only 7 days at a time. One pediatrician quoted in the article stated, ” We literally give it like water.”
Many children are routinely put on Miralax for years, and are completely unable to have a bowel movement without it. It has become a “no fuss” solution to this most troubling and debilitating symptom, which is often extremely difficult to treat. The active ingredient in Miralax is polyethylene glycol 3350, or PEG, an osmotic laxative. It draws water into the bowel and produces a watery rather than a formed bowel movement.
The mainstream medical position has been that PEG is minimally absorbed from the intestine, and thus poses no systemic risk. But there are many anecdotal reports by parents of very serious adverse side effects of this medication, particularly neuropsychiatric symptoms, mood and anxiety symptoms, tics, self-stimulating repetitive behaviors, seizures, to name only a few. A Yahoo group dedicated to this concern has over 1700 members.
“Last week the Empire State Consumer Project, a New York consumer group, sent a citizen petition to the F.D.A. on behalf of parents concerned about the increase in so-called adverse events related to PEG that health professionals and consumers have reported to the F.D.A. over the past decade.” The agency declined to comment, despite the fact that in 2009 their oversight board concluded, “little is known about whether absorption in children differs from adults, especially in children who are constipated, have underlying intestinal disease, or are very young.” At that time the FDA, nevertheless, determined that no action was necessary “based on available information.”
The article referenced conventional wisdom regarding the causes of constipation, such as too few fruits and vegetables in the diet, excess dairy, poor hydration, too little exercise, stress. What it did not mention, and what is in my mind the primary cause, is that many people today have deficient or pathological gut microflora. This is due to the over prescription of antibiotics which damage the gut microflora, a diet high in refined carbohydrates which feeds pathogenic varieties of intestinal flora, the ubiquitous use of hormones, such as contraceptives, which damage the intestinal flora, and the overall toxicity of our environment.
Dr Natasha Campbell-McBride , author of the Gut and Psychology Syndrome, believes that constipation is a condition reflecting gut dysbiosis, and all of her recommendations for the GAPS healing protocol are designed to heal and seal the gut through rebalancing the microflora. This is achieved through a whole foods diet, high in animal fat which promotes healing and lubrication of the gut, fermented foods, probiotics, a few supplements and detoxification.
Dr Campbell-McBride is very much opposed to the use of laxatives. She suggests that for cases of persistent constipation, which do not respond to diet, that nightly enemas be administered to ensure regular bowel movements. In this country we are not at all comfortable or familiar with the use of enemas, but they are a traditional time honored effective remedy around the world for treatment of a variety of conditions. Enemas heal the underlying pathology involved in constipation, whereas Miralax simply provides a Band-aid. The long term consequences of chronic Miralax use are unknown, and as mentioned above, according to numerous anecdotal reports, many children, even in the short term, are suffering serious side effects.
According to Dr. Natasha Campbell McBride, enemas provide:
- Prompt and effective relief of chronic constipation.
- Removal of fecal compaction within the bowel, and reduces toxins produced by accumulating putrefaction. Allows the introduction of friendly bacteria.
- Using probiotics in the enema ensures delivery of friendly bacteria to the colon that might otherwise be destroyed by stomach acid in foods consumed.
- The motion of gentle filling and emptying of the colon increases peristaltic (muscular contraction) activity by which the colon naturally moves material out of the digestive tract.
- Improvement in the quality and frequency of bowel movements
Constipation often produces encopresis, or fecal incontinence, in children. Infrequent bowel movements result in large, hard dry stools that are painful to pass. The children thus often develop dysfunctional bowel habits like holding in their stool, or clenching, and then have accidents. Defecation of the hardened stool can result in tearing of the delicate anal tissue and painful bleeding anal fissures can occur. Sometimes stool becomes impacted in the colon and rectum and wet stool leaks around the blockage resulting in incontinence. This is very traumatic for all concerned with the mess and smell, our visceral aversion to feces and its total lack of social acceptability.
One practitioner, a behavioral psychologist named Dr. Robert Collins, has developed a whole protocol for treating encopresis that is called Soiling Solutions, and involves a very detailed behavioral approach to the problem through the use of enemas and suppositories. His recommendations may fill a need for parents who have no idea how to go about bowel retraining. He provides a manual with careful step by step guidelines for implementation of his treatment protocol. Dr. Collins maintains that his aggressive home-based treatment effects an eventual cure though a training process where the daily treatment hour shortens over time as the child’s body/mind takes over by a natural conditioning process. His is a “bottom up” approach with consistent daily voiding to promote bowel competence, rather than the conventional “top down” approach with oral agents like Miralax.
Psychological treatment is also indicated in cases of encopresis. The stress and shame of this very difficult and often intractable condition can adversely affect the self esteem of the child, and the whole family needs emotional support to handle it optimally.
I originally wrote this post in May of 2012. It’s now January 2015. Some posts, like this one, continue to generate interest. This post was just referenced in an excellent piece called “What Can You Do When Your Kid Can’t, You Know…GO?” It describes a number of very practical and benign strategies to treat this very common and vexing problem. It’s a valuable resource that provides many effective alternative approaches to Miralax.
“What To Do When Your Kid Can’t, You Know…Go?” was featured on a website called “Thinking Mom’s Revolution,” which is sponsored by a group of “twenty-three moms and one brave dad. Their group stretches from Montana to Malaysia to Montreal. While parenting children with autism spectrum disorder, chronic childhood diseases and disabilities, they came together to collaborate about biomedical, alternative healing modalities and dietary interventions, as well as doctors and researchers developing cutting edge treatments. In the process they became a tight-knit family dedicated to helping their children lose their diagnoses.” There is an enormous wealth of useful and fascinating information to explore on this site, and I highly recommend it to my readers.