Laxative Abuse: A Colitis Trigger?

Laxative abuse is a serious condition that can have dangerous consequences for a person's health. It is often associated with eating disorders, particularly bulimia nervosa, where individuals engage in binge-eating and purging behaviours. Those struggling with constipation may attempt to self-treat with over-the-counter laxatives, which can lead to abuse and addiction. The abuse of laxatives can cause a range of adverse effects, including gastrointestinal disturbances, cramping, nausea, and cardiovascular complications due to severe electrolyte imbalances. It can also worsen constipation and lead to laxative dependency, requiring higher doses over time.

Laxative abuse and eating disorders

Laxatives are medications used to treat constipation by softening stools or stimulating the lower intestine to push out stool. While doctors may recommend their occasional use, people with eating disorders may use them frequently or daily. Laxative abuse is the repeated use of laxatives to purge calories or food. This is based on the incorrect belief that laxatives will quickly move food through the body and clear out calories before they are absorbed. However, laxatives primarily affect the lower digestive tract, and by the time they act on the large intestine, most foods and calories have already been absorbed by the small intestine.

Laxatives are sold over the counter and are easy to obtain. Individuals with eating disorders may disregard warnings about their use. Many people who abuse laxatives will take more than the suggested dose and continue to increase that dose as the body becomes accustomed to the additional assistance. This can lead to laxative dependency, where the bowel's natural ability to function is diminished, requiring increased doses to achieve the desired effect. This cycle of dependence not only exacerbates constipation when laxative use is stopped but also significantly increases the risk of long-term gastrointestinal damage.

Laxative abuse carries a multitude of risks, affecting nearly every system in the body. It can lead to dehydration, as laxatives increase fluid expulsion from the body. This can cause symptoms such as thirst, dry skin, and fatigue. More dangerously, it can cause electrolyte imbalances—alterations in the levels of essential minerals like potassium, sodium, and magnesium, which are critical for nerve and muscle function. These disruptions can result in arrhythmias, muscle weakness, and even seizures.

Chronic laxative use can also lead to a range of gastrointestinal issues, including intestinal nerve damage, colon infections, and, paradoxically, chronic constipation. In severe cases, laxative misuse can cause ischemic colitis, a condition where blood flow to the colon is reduced, leading to inflammation and ulceration. Additionally, the overuse of stimulant laxatives can wear down the colon's lining, increasing the risk of infections. Laxative abuse is also associated with irritable bowel syndrome.

Laxative abuse is often intertwined with eating disorders, where the misuse of laxatives is a symptom of a larger psychological issue. This relationship highlights the need for a comprehensive approach to treatment that addresses both the physical and mental health aspects of abuse. Overcoming laxative abuse requires working with a team of health professionals, including a physician, psychiatrist, psychotherapist, and dietician. Support from healthcare providers, therapists, and family is important, as people who have abused laxatives may feel the urge to start using them again. Developing healthy coping skills, self-confidence, and self-acceptance is crucial in helping individuals embrace their bodies and resist relapsing.

Short- and long-term health risks of laxative abuse

Laxatives are a type of medication used to treat constipation. They are relatively safe and available over the counter or without a prescription. However, laxatives are sometimes misused or abused by people trying to lose weight or control their body weight. This practice can have serious short- and long-term health risks.

Short-term health risks of laxative abuse

• Gastrointestinal discomfort
• Gas
• Loose stool
• Diarrhea
• Rectal irritation
• Dehydration
• Electrolyte imbalance
• Urinary tract infections (UTIs)
• Organ damage

Long-term health risks of laxative abuse

• Chronic constipation
• Laxative dependency
• Irritable bowel syndrome (IBS)
• Acute renal failure (kidney failure)
• Hepatic failure (liver failure)
• Pancreatitis (inflammation of the pancreas)
• Cardiovascular disease
• Increased risk of colon cancer
• Depression and anxiety
• Rectal prolapse

Laxative abuse and the risk of colon cancer

Laxatives are medicines that treat constipation, making it easier to pass stools. They can be purchased over the counter without a prescription, but they are not suitable for long-term use. Laxative abuse is the repeated use of laxatives to purge calories or food. It is often associated with eating disorders.

Laxative abuse can cause severe dehydration, mineral deficiencies, and electrolyte disturbances, which can lead to tremors, blurry vision, fainting, kidney damage, and even death. It can also cause long-term damage to the digestive system, including chronic constipation, a "lazy colon", irritable bowel syndrome, and, in rare cases, liver damage.

The abuse of laxatives has also been linked to an increased risk of colon cancer. While the mechanism is not yet fully understood, studies have shown that long-term inflammation caused by laxative abuse may increase the odds of abnormal cell development during the healing process.

One study published in the Annals of Epidemiology found that the use of non-fibre laxatives was associated with a more than two-fold increase in the risk of colorectal cancer. In contrast, fibre-based laxatives were not linked to an increased risk.

It is important to note that laxative abuse can have serious health consequences and should not be used as a weight-loss tool. If you or someone you know is struggling with laxative abuse or an eating disorder, seek professional help from a qualified healthcare provider.

Signs and symptoms of laxative abuse

Laxative abuse is a serious issue that can have dangerous consequences for a person's health. It is often associated with eating disorders such as anorexia nervosa and bulimia nervosa, but it can also be a problem for those struggling with constipation who attempt to self-treat the issue. Here are some signs and symptoms to look out for if you suspect that someone may be abusing laxatives:

Behavioural Symptoms:

• Going to the restroom immediately after eating
• Lying about eating habits and laxative use
• Wearing oversized clothing to hide weight loss
• Purchasing laxatives regularly and from different stores
• Hiding laxatives to conceal abuse
• Developing ritualistic behaviour patterns around laxative use
• Switching between different types of laxatives
• Avoiding situations where laxatives cannot be used

Physical Symptoms:

• Frequent bowel movements
• Recurring bouts of chronic constipation and diarrhoea
• Gastrointestinal disturbances (e.g. chronic bloating, heartburn, gas)
• Abdominal cramps and stomach pains
• Nausea and/or vomiting
• Shaking, tremors, or muscle cramps
• Dehydration and electrolyte imbalances
• Dizziness and poor coordination
• Halitosis (bad breath)

Psychosocial Symptoms:

• Feeling anxious when unable to use or acquire laxatives
• Feeling a sense of euphoria after a bowel movement
• Preoccupation with laxative use and weight
• Poor impulse control
• Pulling away from family and friends
• Excessive weight monitoring
• Negative comments about self or others regarding weight or body size

It is important to be aware of these signs and symptoms as laxative abuse can lead to severe health complications, including organ damage, heart problems, and an increased risk of colon cancer. If you or someone you know is exhibiting these signs, it is crucial to seek professional help to address the issue and any underlying eating disorders or mental health concerns.

Treatment for laxative abuse

The first step in treating laxative abuse is to determine what may be promoting the behaviour, such as an eating disorder or misinformation about healthy bowel habits. The next step is to stop the use of stimulant laxatives and replace them with fibre or osmotic supplements to establish normal bowel movements.

For those with severe cases of laxative abuse, hospitalization may be required prior to therapeutic treatment. This may include rehydration through intravenous methods, or antibiotics to treat colon infections.

Following this, individuals can participate in inpatient programming, partial hospitalization programming, or outpatient programming. Inpatient treatment is best suited for those with a serious problem with laxatives, and involves residing at a facility with others in recovery, receiving both medical and therapeutic services. Partial hospitalization treatment can benefit those who do not require inpatient programming but need more structure than an outpatient program. Outpatient programming is designed for those who do not have a severe case of laxative abuse, and allows individuals to attend the program for a few hours a day or a couple of days a week.

In addition to these treatment programs, support from healthcare providers, therapists, and family is important. Individuals recovering from laxative abuse may feel the urge to start using laxatives again, so developing healthy coping skills, self-confidence, and self-acceptance is crucial.

Frequently asked questions