Chronic Laxative Use: Bowel Dependency

Laxatives are commonly used to treat constipation by loosening stools or stimulating the bowels. While they are relatively safe and available over the counter, they can also be misused or overused, leading to dependency and negative effects on the digestive system. People with eating disorders may abuse laxatives to purge calories or food, or to achieve their ideal body weight. This can cause long-term damage to the digestive system, including chronic constipation, impaired intestinal function, and damage to the nerves and muscles of the colon. It is important to gradually reduce laxative use, drink plenty of water, increase dietary soluble fibre, and get regular physical activity to reverse laxative dependency and restore a healthy digestive system.

Laxative abuse and eating disorders

Laxatives are medications that treat constipation by softening stools or stimulating the lower intestine to push out stool. They are easily accessible over-the-counter medicines that, when abused, can wreak havoc on the body. Laxative abuse is a common issue for people with eating disorders, who use them to purge calories or food. The misconception is that laxatives can aid in weight loss by quickly moving food through the body and clearing out calories before they are absorbed. However, this is not true, as by the time laxatives act on the large intestine, most nutrients and calories have already been absorbed by the small intestine. The weight loss experienced is mainly due to water loss, which returns as soon as the individual rehydrates.

The Dangers of Laxative Abuse

Laxative abuse can cause a multitude of health issues, including:

• Dehydration and electrolyte imbalances: Laxatives increase fluid expulsion from the body, leading to dehydration and the loss of essential electrolytes like potassium, sodium, and magnesium. These imbalances can result in arrhythmias, muscle weakness, and seizures.
• Gastrointestinal complications: Chronic laxative use can lead to intestinal nerve damage, laxative dependency, and severe conditions like ischemic colitis. Overuse can also wear down the colon's lining, increasing the risk of infections and chronic constipation.
• Psychological impact: Laxative abuse is often intertwined with eating disorders and can lead to stress, shame, and social isolation.
• Malnutrition and mineral deficiencies: The loss of water and electrolytes can also lead to mineral deficiencies and malnutrition, causing further health complications.
• Damage to the digestive system: Laxative abuse can cause long-term and potentially permanent damage to the digestive system, including chronic constipation, impaired intestinal function, and damage to the nerves and muscles of the colon.
• Infections: Laxatives strip away the protective mucus and bacteria in the intestines, leaving them vulnerable to infection and irritation.
• Rectal prolapse: Chronic severe diarrhea caused by laxative abuse can cause the inside of the intestines to protrude through the anal opening, requiring surgical treatment.

Treatment for Laxative Abuse

Overcoming laxative abuse requires addressing both the physical and psychological facets of the issue. Treatment often involves:

• Medical intervention and detoxification: The first step is often a medically supervised detoxification process to manage withdrawal symptoms and restore fluid and electrolyte balance.
• Psychological support and therapy: Psychological therapy, such as CBT and DBT, can help address the underlying issues contributing to the abuse, such as body dysmorphia and low self-esteem.
• Nutritional counseling and rehabilitation: Dietitians and nutritionists can create personalized eating plans to ensure adequate nutrition and repair any damage caused by misuse.
• Ongoing support and relapse prevention: Support groups and relapse prevention plans are crucial for sustained recovery.

The vicious cycle of laxative use

Laxatives are often used to treat constipation, but when overused, they can lead to a vicious cycle of physical dependence and worsening constipation. This cycle can be challenging to break and may have serious health consequences.

How Laxatives Work

Laxatives work by stimulating the lower intestine to push out stool, making it easier to pass. They can be taken orally or rectally and typically provide relief within 12 to 72 hours. However, some types, like enemas and suppositories, act much faster, usually within minutes to an hour.

The Onset of Dependence

The overuse of laxatives can lead to physical dependence, as the body becomes accustomed to their assistance in moving waste through the body. This dependence can develop more quickly than expected, and individuals may find themselves needing higher and higher doses to achieve the desired effect.

Worsening Constipation

Paradoxically, the overuse of laxatives can actually worsen constipation over time. This is because laxatives overwork" the digestive tract, reducing muscle tone and nerve signalling in the colon. This can slow down digestive muscle contractions, making it more difficult for the body to move stool out naturally.

The Cycle Continues

As constipation worsens, individuals may turn to laxatives even more frequently, increasing the dosage or taking them for longer than recommended. This can lead to a cycle of laxative dependence, where the body becomes unable to function properly without the aid of these medications.

Breaking the Cycle

Breaking the cycle of laxative dependence can be challenging and may require medical intervention. It is important to gradually reduce the use of laxatives, as stopping abruptly can cause unpleasant side effects such as bloating, cramping, and constipation. Seeking professional help is crucial, especially if there are underlying eating disorders or mental health issues contributing to the laxative abuse.

How to reverse laxative dependency

Yes, bowels can become laxative-dependent. Laxatives are substances or medications that encourage bowel movements by loosening stools or stimulating your intestines. However, overuse or misuse can lead to dependency and negatively affect your digestive system.

Reduce laxative use

Start by gradually decreasing your dosage of stimulant laxatives or stop taking them immediately. You can supplement with osmotic laxatives if necessary. It's important to cut down your dosage gradually to minimise discomfort, rather than stopping abruptly.

Drink plenty of water

Aim to drink around eight 8-ounce glasses of water daily. Staying well-hydrated is crucial for digestive health, as it helps promote regular bowel movements and softens stools. While water is the best source of hydration, you can also include other non-caffeinated, non-alcoholic fluids, such as herbal teas and clear broths, to increase your overall fluid intake.

Increase dietary soluble fibre

Focus on eating a well-balanced and fibre-rich diet. Aim for about 30 grams of fibre per day, but make changes gradually to give your body time to adjust. Soluble fibre absorbs water and forms a gel-like substance, increasing stool bulk and softness. Foods rich in soluble fibre include fruits, vegetables, whole grain breads and cereals.

Consider fibre and probiotic supplements

If your dietary fibre and probiotic intake is low, taking supplements may be beneficial. Fibre supplements such as glucomannan, psyllium husk, and guar fibre can help, but introduce them slowly and drink plenty of water to reduce stomach discomfort. Probiotic supplements provide beneficial bacteria that support a healthy balance of gut microbiota, ensuring proper digestion and overall gut health.

Engage in regular physical activity

Incorporate regular exercise such as walking, swimming, or dancing into your routine. Practices like yoga, pelvic floor exercises, and deep breathing exercises are also effective. Exercise can stimulate bowel function and contribute to good digestive health.

Try grazing or structured meals

Eating smaller, more frequent meals can help manage laxative dependency by supporting consistent nutrient intake and steady digestion. Grazing throughout the day can also help stabilise blood sugar levels and provide sustained energy release. On the other hand, having three full meals can help regulate bowel movements and contribute to a steady release of nutrients.

Establish a bathroom routine

Try going to the bathroom about 30 minutes after eating. This encourages natural bowel movements by making you more attuned to your body's signals. Having a set time for bowel movements can help establish regularity and enhance your mind-body connection.

It's important to remember that reversing laxative dependency is a gradual process, and the timeline for reversal will vary depending on your overall health, the severity of your dependency, and your response to diet and lifestyle changes. If you experience severe symptoms or constipation persists, seek medical attention.

Side effects of laxative overuse

Yes, bowels can become laxative dependent. The overuse of laxatives can lead to a range of side effects, including:

Dehydration

Laxatives remove water from the body, and if this fluid loss is not addressed, dehydration can occur. Dehydration puts stress on the organs and can be fatal if not treated promptly. Symptoms of dehydration include thirst, decreased urination, headaches, light-headedness, diminished sweating, dry mouth, weakness, and fatigue.

Electrolyte Abnormalities

Electrolytes such as sodium, potassium, and chloride are lost at abnormally high rates through diarrhoea caused by laxative abuse. This can lead to weakness, irregular heartbeats, and even sudden death.

Impaired Intestinal Function

Long-term laxative abuse can cause intestinal muscles to weaken and lose their normal function, leading to a "lazy colon" that can no longer evacuate stool normally. This can result in irritable bowel syndrome and chronic constipation.

Infections

The intestines are normally coated with a protective layer of mucus and contain beneficial bacteria that are necessary for immune system function and overall health. Laxative abuse strips away this protective mucus and bacteria, leaving the intestines vulnerable to infection and irritation. Abusing laxatives may also increase the risk of colon cancer.

Rectal Prolapse

Chronic severe diarrhoea caused by laxative abuse can cause the inside of the intestines to protrude through the anal opening, a condition that usually requires surgical treatment.

Depression

Constipation due to laxative abuse can lead to physical discomfort and social isolation, contributing to feelings of depression, shame, and anxiety.

Laxatives and weight loss

Laxatives are medications that stimulate bowel movements or loosen up stools to ease their passage. They are meant to treat constipation, a condition caused by infrequent, painful or difficult bowel movements. However, they have also become a popular method for weight loss. Many people believe that using laxatives can help increase the frequency of bowel movements and allow for quick, easy and effortless weight loss.

How Laxatives Work

There are a few different classes of laxatives that work in different ways. The main types are:

• Stimulant laxatives speed up the movement of the digestive tract.
• Osmotic-type laxatives cause the colon to retain more water, which increases bowel movement frequency.
• Bulk-forming laxatives move through the intestines undigested, absorbing water and adding bulk to the stool.
• Saline laxatives draw water into the small intestine, which helps promote a bowel movement.
• Lubricant laxatives coat the surface of the stool as well as the lining of the intestines to ease bowel movements.
• Stool softeners allow the stool to absorb more water, making it softer for easier passage.

It is true that laxatives may help increase weight loss, but the results are only temporary. Several types of laxatives work by pulling water from your body into the intestines, allowing the stool to absorb more water for an easier passage. With this method, the only weight you lose is from the water you excrete through the stool.

To date, there have been no studies supporting the idea that laxative use can lead to lasting weight loss. Instead, it can lead to dangerous side effects like dehydration, electrolyte imbalance and possibly even dependence.

Safe Weight Loss Strategies

If you are trying to lose weight, there are safer and more effective methods than using laxatives:

• Eat more fruits and vegetables: They’re low in calories but rich in fibre. A higher intake of fruits and vegetables has been associated with lower body weight.
• Increase your physical activity: Participating in aerobic exercise a few times a week can aid in weight loss and help prevent weight regain.
• Reduce your portion sizes: Smaller portions mean fewer calories.
• Eat a high-protein breakfast: Starting your day with a protein-packed breakfast reduces appetite and food intake over the course of the day.
• Decrease your intake of added sugars: Sugar is high in calories, low in nutrients and leads to weight gain.

Frequently asked questions