Laxative Abuse: Myths and Medical Complications

Reprinted from Eating Disorders Review
September/October 1999 Volume 10, Number 5
©1999 Gürze Books

MYTH: If you induce diarrhea with laxatives, you can prevent the absorption of food and avoid body weight gain.

FACT: Inducing diarrhea by laxatives does not significantly change the absorption of food in the body. Consequently, laxatives do not significantly prevent weight gain. What appears to be weight loss is actually dehydration or water deprivation. Laxatives work near the end of the bowel, where they primarily affect absorption of water and electrolytes (like sodium and potassium). They thus work after most of the nutrients from the food have been absorbed into the body.

MYTH: You need to use a laxative every time you feel constipated.

FACT: “Feeling” constipated does not necessarily mean that you are constipated. This is especially true of people who have problems with eating. Eating too little food or eating sporadically can result in the sensation of constipation. In this case the problem is not constipation but poor eating habits.

MYTH: When you actually are constipated, you need to use a laxative.

FACT: People who use excessive amounts of laxatives will eventually find the exact opposite happening—the laxatives will cause reflex constipation.

MYTH: All laxatives are alike.

FACT: There are many different types of laxatives that are taken by mouth or as a suppository. The ones most commonly used are:

Stimulant-type laxatives, including Ex-Lax®, Correctol®, Senokot®, Ducolax®, Feen-a Mint®, and some of the so-called herbal laxatives.

Osmotic-type laxatives, including Milk of Magnesia®.

Bulk agents, including Metamucil®, Colace®, and unprocessed bran. Bulk agents promote bowel movement. When bulk agents are used as directed (with large amounts of water), they don’t have the same physical effects on the bowel as the stimulant and osmotic laxatives. However, when these bulk agents are misused, they have the same psychological consequences as regular laxatives. Misusing these agents must be discontinued.

MYTH: Laxatives, particularly over-the-counter products, are safe.

FACT: Laxative abuse can be medically dangerous. Laxative abuse is defined as (1) use of laxative for weight control, or (2) frequent use of laxatives over an extended period of time.

Medical Complications of Laxative Abuse

The medical complications of laxative abuse depend on several factors, including the type of laxatives used, the amount used, and how long they have been used. Some of the more common complications of laxative abuse follow.

Constipation. Repeated use of laxatives actually causes constipation. This may lead people to increase the dosage of the amount of laxative, which in turn only worsens the constipation problem.

Dehydration. Laxatives cause fluid loss through the intestines. Dehydration then impairs body functioning.

Electrolyte abnormalities. Many people who abuse laxatives often demonstrate electrolyte imbalances. Electrolytes such as potassium, sodium, and chloride are important to life functions. With chronic diarrhea, electrolytes are drawn out of the body through the feces. This leads to an electrolyte imbalance in the body.

Edema. As noted before, laxatives cause fluid loss. Dramatic changes or fluctuations in fluid balance confuse the body’s self-regulating protective mechanisms by retaining fluid. As a result, prolonged laxative abuse frequently leads to fluid retention or edema.

Bleeding. People who abuse laxatives, especially the stimulant-type laxatives, can develop blood in their stools. Chronic blood loss associated with laxative abuse can lead to anemia.

Impaired bowel function. People who abuse stimulant-type laxatives can develop permanent impairment of bowel function.

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