I used to think the same thing about Lactulose. It really didn’t make my husband’s bowels move. In fact, he was constipated much of the time. As you’ve seen stated here many times, every individual is different.
When my husband was hospitalized, I complained to the hepatologist that the Lactulose just didn’t work. Of course, he increased the dosage and my husband ended up with diarrhea. They would back off the Lactulose and he would get constipated again. He was taking 30ml 3-4 times per day at the hospital. When he was extremely confused, they would administer Lactulose enemas. The whole bottle goes in!
Lactulose binds with ammonia and other toxins and draws them to the intestines. The patient must evacuate the intestines in order to get the toxins out of the system. Trust me, Lactulose works. It’s just a matter of finding the right dosage.
You may have heard of Xifaxin. It is an antibiotic that works within the intestines to control the bacteria that produce ammonia. You may want to speak with his doctor about this.
Best wishes to you. I’ve been there and done that. It is a long and difficult road.