Oral Cleanout Protocol
For children who have severe constipation or encopresis (involuntary stool accidents in their underwear), it is often necessary to give a large amount of liquid and laxative to clean out the stool impaction. The following regimens are recommended on a weekend day when you and your child can stay close to home for frequent use of the toilet. Start first thing in the morning, as this process can take several hours.
7 Years or Older
- Take Senna (Senokot) 1 tablespoon or 1 tablet, or 1 chocolate Ex-Lax square.
- Wait 1 hour.
- Mix 15 capfuls of Miralax with 48-64 ounces of Gatorade (not red Gatorade). Child should drink this over several hours. If your child is hungry, their diet should only be clear liquids, such as chicken broth, clear tea, jello (not red), while doing this cleanout.
- Wait 1 hour after completing the Miralax and then give a second dose of Senna (Senokot) or Ex-Lax. If cleanout is successful, the child should be stooling clear Gatorade.
- If the child is not stooling clear Gatorade, when cleanout is done, then repeat the cleanout again the following day.
- Once the cleanout is successful, the next day, your child should start ½-1 cap of Miralax mixed in 4-8 oz of water, daily. Child should have a soft but formed stool at least once a day. Take 1 dose of Senna (Senokot) at bedtime if no stool on a given day.
Less Than 7 Years
- Take Senna (Senokot) 1 tablespoon or 1 tablet, or 1 chocolate Ex-Lax square.
- Wait 1 hour.
- Mix 5-10 caps of Miralax with 32-48 ounces of Gatorade (not red Gatorade). Child should drink this over several hours. If your child is hungry, their diet should only be clear liquids, such as chicken broth, clear tea, jello (not red), while doing this cleanout.
- Wait 1 hour after completing the Miralax and then give a second dose of Senna (Senokot) or Ex-Lax.
- If the child is not stooling clear Gatorade, when cleanout is done, then repeat the cleanout again the following day.
- Once the cleanout is successful, the next day, your child should start taking ½-1 cap of Miralax mixed in 4-8 ounces of water, every day. Child should have a soft, but formed stool at least once a day. Take 1 dose of Senna (Senokot) at bedtime if no stool on a given day.
In addition to daily Miralax, your child should be on a table to toilet routine. They should go from the table to the toilet after breakfast, after snack when they get home from school, and after dinner. Sit for 10 minutes to try to stool. Complete chart and bring with you to your follow up appointments.
