I am a nurse. My pt had a bowel resection several years ago, currently being treated for COPD exacerbation (heavy mouth-breather), drinks abt 750ml h20 daily, eats prunes, and takes senna 8.6mg & Colace 100mg bid. Activity is limited. No narcotic use. She states Miralax is ineffective. She reports hard stool in the vault and must strain to pass. I know she can double up on her bowel treatment but, would something else be more effective?