Thanks for your concern about your wife s health. I certainly would not recommend administering a double dose of Miralex, as this can have untoward consequences, like triggering off a series of loose motions and the like. I would directly answer your question in another way. Have you spoken with her doctor (a neurologist), about treatment with a medication for ALS, called as Mestinon (Pyridostigmine)? Mestinon helps produce bowel motions as well. The increased bowel motions are actually a useful side effect of Mestinon for people who have ALS with constipation. Alternatively I would strongly suggest, Dulcolax suppositories as an adjunct. The bowels are best emptied when the body is in a squatting position over the commode. This triggers the movement of waste out of the bowels. I hope this helps.