Laxative Immunity: Fact Or Fiction?

Laxatives are commonly used to treat constipation, but they can also be misused by people with eating disorders as a weight-loss tool. While laxatives can be purchased over the counter without a prescription, they can have serious side effects when abused or used excessively, including dehydration, mineral deficiencies, and long-term damage to the digestive system. With repeated use, the body can become dependent on laxatives, requiring higher doses over time. This can lead to a vicious cycle of constipation, diarrhoea, and gas, as well as more serious health complications.

Laxative abuse and eating disorders

Laxatives are commonly misused by patients with eating disorders, particularly those with bulimia nervosa and the binge-purge subtype of anorexia nervosa. Laxatives are used as a method to purge, or remove food consumed from the body, to prevent weight gain or promote weight loss. This is a dangerous practice with significant health implications.

People with eating disorders may turn to laxatives as a method to expel food quickly from the body. This is a misunderstanding as laxatives primarily affect the lower digestive tract, long after most calories have been absorbed. The weight loss experienced is mainly due to water loss, leading to temporary changes in body weight but not affecting body fat.

The Dangers of Laxative Abuse

Laxative abuse can lead to a range of gastrointestinal issues, including intestinal nerve damage, laxative dependency, and severe dehydration. It can also cause electrolyte imbalances, which can result in arrhythmias, muscle weakness, and seizures. Chronic laxative use can also increase the risk of long-term gastrointestinal damage, such as ischemic colitis and colon infections.

Treatment for Laxative Abuse

Overcoming laxative abuse requires addressing both the physical and psychological aspects of the problem. Medical intervention is often necessary to manage withdrawal symptoms, which can include severe constipation, bloating, abdominal pain, and psychological distress. Psychological therapy, such as cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), can help address the underlying issues contributing to the abuse, such as body dysmorphia, low self-esteem, and unhealthy coping mechanisms. Nutritional counseling is also important to ensure balanced and adequate nutrition and to repair any damage caused by misuse.

The dangers of laxative abuse

Laxatives are medicines used to treat constipation by softening stools or stimulating the lower intestine to push out stool. While laxatives are meant to be used occasionally, people with eating disorders may use them frequently or even daily. This is called laxative abuse or misuse. Laxative abuse is the repeated use of laxatives to purge calories or food in an attempt to lose weight, "feel thin", or "feel empty".

Laxatives are sold over the counter and are easy to obtain. However, they can have serious negative health effects when abused. The most common consequence of laxative abuse is dehydration, which can lead to tremors, weakness, blurry vision, fainting, kidney damage, and even death. Laxative abuse can also cause electrolyte disturbances, specifically sodium, potassium, magnesium, and phosphorus imbalances, which are necessary for the proper functioning of nerves and muscles, including those of the colon and heart.

Another consequence of laxative abuse is constipation. Paradoxically, laxatives can cause "reflex constipation" as the bowel loses its ability to perform its natural function. This can lead to individuals increasing the dosage of laxatives, exacerbating the problem. Laxative abuse can also cause permanent impairment of the digestive system, including paralysis of the muscles used in digestion, which may require surgical removal of part or the entire colon and dependence on a colostomy bag.

Laxative abuse can also increase the risk of colon cancer and other infections. The abuse of laxatives can strip away the protective layer of mucus in the intestines, leaving them vulnerable to infection and irritation. Additionally, abusing laxatives can lead to rectal prolapse, where chronic severe diarrhea causes the inside of the intestines to protrude through the anal opening, often requiring surgery.

The psychological effects of laxative abuse cannot be overlooked. Individuals with eating disorders may become addicted to laxatives, experiencing feelings of euphoria after bowel movements and developing obsession and ritualistic behaviours surrounding their use. Laxative abuse can also lead to social isolation, stress, and shame.

Overall, laxative abuse can have severe physical and psychological consequences, and it is important to seek help from a team of medical and mental health professionals if you or someone you know is struggling with this issue.

How laxatives work

Laxatives are a type of medicine used to treat constipation. They are available over the counter in pharmacies and supermarkets, as well as on prescription from a doctor. They are typically used when lifestyle changes, such as increasing fibre intake, drinking more fluids, and exercising, have not helped with constipation.

There are four main types of laxatives: bulk-forming, osmotic, stool softeners, and stimulants. Bulk-forming laxatives, also known as fibre supplements, work by increasing the weight of the stool, which stimulates the bowel. They do this by drawing water from the body into the stool, making it bigger, softer, and easier to pass. Osmotic laxatives also draw water into the bowel, but from other parts of the body, and they can hold water in the stool to make it softer. Stool softeners, also called emollient laxatives, increase the water and fat that the stool absorbs, softening it. Lubricant laxatives, such as mineral oil, coat the colon, preventing water absorption from the stool and making it slippery and easier to pass.

Stimulant laxatives are different from the other types in that they do not work by softening the stool. Instead, they stimulate the nerves that control the muscles in the colon, forcing it into motion to move the stool along. These are typically used when other over-the-counter laxatives have not helped.

Laxatives should be taken as directed to prevent side effects, which can include bloating, gas, stomach cramps, and dehydration. They should only be taken occasionally and for up to a week at a time, and it is important to drink plenty of fluids when taking them. Overuse of laxatives can lead to serious long-term complications, including damage to the digestive system and colon.

Types of laxatives

There are several types of laxatives, each working in a different way to treat constipation. The four main types are:

Bulk-forming laxatives

These work by increasing the weight of poo, which stimulates the bowel. They usually take 2-3 days to work. Examples include Fybogel (ispaghula husk), psyllium, and methylcellulose.

Osmotic laxatives

Osmotic laxatives draw water from the body into the bowel to soften poo and make it easier to pass. They also take 2-3 days to work. Examples include lactulose, macrogol, and magnesium hydroxide solution.

Poo-softener laxatives

Poo-softener laxatives, also called emollient laxatives, work by letting water into the poo to soften it and make it easier to pass. An example is docusate.

Lubricant laxatives

Lubricant laxatives coat the colon, making it slippery. This prevents the colon from absorbing water from the poo, so it stays soft and is easier to pass. An example is mineral oil.

Stimulant laxatives

Stimulant laxatives activate the nerves that control the muscles in the colon, forcing it into motion so it moves the poo along. Examples include bisacodyl and senna.

Other types of laxatives include prescription-only laxatives and enemas. Laxatives are available over the counter or on prescription from a doctor.

Signs of laxative abuse

While laxatives are relatively safe when used as directed, they can be extremely harmful when abused. Laxative abuse is the repeated use of laxatives to purge calories or food. It is often associated with people who have body dysmorphia or eating disorders such as anorexia nervosa and bulimia nervosa. Laxative abuse can cause severe physical and mental health issues, and in some cases, even death.

Laxative abuse can be difficult to spot, but there are some signs and symptoms that may indicate a person is abusing laxatives. Some behavioural signs include:

• Taking pills (or drinking water mixed with powder) before or immediately after meals
• Spending time in the bathroom following meals or snacks
• Rearranging social, school, or work obligations around bathroom breaks
• Urgency to use the bathroom after meals
• Hiding laxatives or visiting different stores to purchase them
• Lying about using laxatives, cleanses, or herbal supplements meant to cause bowel movements
• Feelings of euphoria after bowel movements
• Obsession and ritualistic behaviours that surround laxative use and bathroom habits
• Other forms of self-harm, such as cutting
• Negative body image or wearing baggy clothing to hide body shape

Physical symptoms that may indicate laxative abuse include:

• Abdominal cramping, potentially severe
• Shivering or shaking
• Chronic stomach pain
• Rectal bleeding or blood in the stool
• Increased dependency on laxatives, and increased doses
• Fluctuations in blood pressure
• Feeling lightheaded or fainting
• Increased feelings of muscle weakness
• Dehydration
• Diarrhea
• Electrolyte disturbances
• Mineral deficiencies
• Urinary tract infections
• Intestinal paralysis
• Heart problems
• Gastrointestinal damage
• Bowel nerve damage
• Increased risk of colon cancer

If you or someone you know is exhibiting signs of laxative abuse, it is important to seek help from a healthcare professional or a specialist in eating disorders.

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