Wetting Accidents and Encopresis
How to determine the correct maintenance dose following a cleanout?

Cleanouts: What Laxative, What Dose, For How Long?

What is a "cleanout"?  A cleanout refers to the process of rapidly removing constipated stool which has backed up in the rectum and, possibly, higher up in the large intestine. This allows new stool to be eliminated when ready.  It is the second of the Six Steps in my book for treating encopresis or functional constipation in children.

Cleanouts are usually done with high doses of a PEG water retention laxative such as Miralax or Restoralax, sometimes in combination with a stimulant laxative.  (If a child's feces are very dry and impacted, a lubricant laxative such as mineral oil may also be necessary.) (See Chapter 11 in my book.) There is no standard cleanout dose for all children just as there is no single standard maintenance dose following the cleanout.  Often, the recommended starting dose of a PEG laxative for a cleanout is "1/2 or more caps". The dose initially recommended by your healthcare provider may be too low and therefore need to be increased.  

The correct cleanout dose produces very loose stool for 1-2 days, followed by a day of mostly liquid or no stool at all, at which time the cleanout is done.

If in doubt about whether a cleanout has been successful, remember that the purpose of a cleanout is to enable your child to move a much larger quantity of poop during the 3-4 days of a cleanout than he/she did in the 3-4 days prior to the cleanout.

PLEASE NOTE: Since your child's poop will be much looser than usual during a cleanout it will be much more difficult for him/her to control. Therefore, for school aged children, I always recommend that cleanouts be done over a weekend or at some other time when your child is not in school.