Treating Constipation with Laxatives: Dependency & Safety in Adults & Children

Written by:
Dr. Ashlea Lytle
September 15, 2021
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Ever since I have been treating constipation and bowel dysfunction as a pelvic health physical therapist, I’ve had many clients ask if the laxative they are taking is safe and if they should continue using it, or if they can start their child on a laxative such as Miralax. Many of my clients are afraid they might become dependent and will always have to be on it for their bowels to function. Or they have been told to stop taking it because it is not safe. To have a better understanding of the risk of dependency on a laxative and its safety, let’s first discuss what it actually is, how it works, its side effects, precautions, why you would use it, and the current research on kids taking it.

Miralax is a non-stimulant, osmotic laxative which contains polyethylene glycol, or PEG 3350. PEG 3350 can be found in many consumer products used today such as certain lotions, creams and makeup, as well as some food additives. Research shows that having an increase in PEG 3350 on a daily basis can increase glycol levels which can cause increased aggression, anxiety and depression in children. But when looking directly at PEG 3350, research shows that while the levels of glycol do increase while taking the medication, they do come back down when intake stops, even after chronic use of PEG 3350. The behavior issues kids are dealing with are more likely to come from chronic constipation. 

Miralax is a non-stimulant which means it does not stimulate your colon to have a bowel movement. Instead, it works by attracting water into the rectum, allowing your stool to absorb more water and soften your feces. If you stop taking it, water will no longer be drawn into your rectum. Taking it can cause increased flatulence, loose stools, nausea, vomiting and abdominal cramping. Sometimes you need to decrease or increase your dosage depending on your symptoms. I would speak to the provider who advised you to take it on how to achieve optimum dosing and results. 

There are a few precautions when taking a laxative. Since it pulls water out of your system you want to make sure you do not have kidney disease. If you already have stomach or intestinal problems (i.e. irritable bowel syndrome, bowel obstruction) or persistent nausea, vomiting, or abdominal pain, you definitely want to check with your doctor first to make sure it is safe for you.  

In my practice some of the clients I typically see using a laxative have chronic constipation, fissures, abdominal pain, bloating, etc. If you have been cleared by your doctor to take a laxative such as Miralax, in my opinion it is safe to stay on it for weeks or even months at a time as long as your symptoms are improving. At the same time you are on a laxative you also need to look at your diet (identifying and eliminating constipating or irritating foods); bowel mechanics (using a step stool with bowel movements); pelvic floor mechanics (can be assessed from a pelvic floor physical therapist); and your exercise routine (are you getting enough exercise?) If you continue your same habits you might have a harder time eliminating laxatives from your daily routine.  

REFERENCES:

Williams, KC, Rogers, LK, Hill, I, Barnard, J., and Di Lorenzo, C. (2018). PEG 3350 administration is not associated with sustained elevation of glycol levels. The Journal of Pediatrics 195: 148-153.

Disclaimer:  The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

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Dr. Ashlea Lytle

VP Colorado Region | Physical Therapist | Doctor of Physical Therapy
Ashlea Lytle is a Doctor of Physical Therapy (DPT) who has been practicing for over a decade in the Denver area. She specializes in sports, general orthopedics, and pelvic health for adults and kids. She splits her time at Activcore in Castle Rock, CO (located inside Optimal Health Chiropractic) and at Activcore in Greenwood Village, CO (located inside Pilates Denver).
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