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Eating disorders are a common phenomenon in today’s world, with millions of people suffering from it. While these disorders are characterized by several noticeable and well-known symptoms, such as binging and purging, some people may adopt other behaviors to keep themselves thin and lean. One of these additional mechanisms a person with an eating disorder attempts to lose weight and body fat involves abusing laxatives.
Laxative abuse is becoming common by the day, likely because the medications are easy to obtain and available over the counter. Due to this easy accessibility, many people believe they are safe to use and abuse. However, experts have uncovered many dangers of laxatives, such as electrolyte imbalance, chronic constipation, and muscle and nerve damage.
Learning about what happens if you take laxatives every day and how to recover from taking too many laxatives is imperative before the habit leads to long-term damage.
Laxative Abuse: An Overview
Laxatives are over-the-counter medications used to manage constipation. These medicines adopt several mechanisms of action to work, such as softening the stools to make their passage easier or triggering the intestines to push out the stool. A doctor may recommend a person with severe constipation to take laxatives; however, these medications are also commonly used by people with eating disorders for non-medical reasons.
Laxative abuse describes the repeated use of these medications to purge food or calories [1]. A large group of people believe that taking laxatives will help their body quickly move food through the digestive system before their calories are absorbed. Based on this belief, they continue abusing laxatives to enjoy food without gaining weight.
Many laxatives available in the market come with warnings not to use them for more than a week to avoid complications. However, a person with an underlying laxative abuse may disregard this warning and continue increasing the dose of the medication until the body becomes dependent on it. Alternatively, they may stay on a small dose but continue using them for longer durations even when their use is not indicated.
Symptoms of Laxative Overuse
If you suspect that someone you love has been excessively using laxatives, watch out for the following behavioral symptoms suggesting an underlying addiction:
- Taking laxative pills or solutions before or immediately after having a meal
- Spending a lot of time in the bathroom before or after mealtimes
- Feeling euphoric after passing a bowel movement
- Rearranging all social, work, or school obligations according to bathroom breaks
- Increasing the number of laxatives consumed
- Practicing other forms of self-harm, such as cutting
- Having a negative body image
- Experiencing feelings of depression, shame, or anxiety
- Wearing loose, baggy clothes to hide the true body shape
- Lying about the use of cleanses, laxatives, or any other herbal supplements that trigger bowel movements
- Hiding laxatives
- Feeling a. urgency to use the bathroom after meals
- Visiting different stores to collect laxatives
- Having ritualistic behaviors surrounding bathroom use and laxative consumption
In addition to the symptoms mentioned above, people with underlying laxative abuse may also experience the following physical symptoms:
- Abdominal cramping
- Sweating
- Shivering or shaking
- Chronic stomach pain
- Nausea and vomiting
- Constipation or diarrhea
- Heart palpitations
- Dehydration
- Headaches
- Rectal bleeding
- Fluctuations in blood pressure
- Increased dependency on laxatives
- Feeling lightheaded or fainting
- Increased feelings of muscle weakness
Overuse of Laxatives Side Effects
Taking laxatives continuously after some time can force the body to start relying on these medications to trigger a bowel movement and get rid of waste from the body. Many people are quick to become dependent on these medications and experience the following side effects:
Constipation
While laxatives are meant to manage constipation, their abuse can worsen the underlying issue. This is because laxatives usually work by artificial irritation or stimulation of the nerves in the large intestine. This stimulation causes the muscles to contract and slowly get the stool out. However, when used for a long time, laxatives end up damaging these nerves. Moreover, people who abuse laxatives also empty their colons most of the time, preventing the organs from working properly and weakening. Together, these side effects can disturb the normal bowel movements of the user and trigger constipation.
Remember that constipation describes a condition where a person has less than three bowel movements per week or when their bowel movements include hard, dry stool that is difficult to pass. Many people with underlying laxative abuse can go without a bowel movement for weeks, experiencing discomfort and abdominal pain.
Combination of diarrhea, constipation, and flatulence
Laxative use can cause the gas to get trapped in the intestines, making a user feel bloated and full. This may cause these users to use more laxatives to treat these symptoms but end up feeling worse. These habits create a vicious cycle where users switch between constipation and diarrhea. These altered bowel habits can sometimes irritate the anus and rectum, causing pain and bleeding while using the toilet. Chronic diarrhea due to laxatives can also cause social embarrassment in many people as they have to rush to use the bathroom multiple times. [2]
Dehydration
While laxatives do not remove calories from the body, they can certainly kick out water. Due to constant diarrhea, a user may continue losing water and becoming dehydrated. This dehydration can put extra stress on the body’s organs and may prove fatal if not treated in time. Some symptoms of dehydration include headaches, decreased urination, thirst, diminished sweating, weakness, dry mouth, fatigue, and lightheadedness.
Hypokalemia
Hypokalemia describes a condition where the blood potassium levels drop to a critically low level. This problem is a hallmark of eating disorders and can occur in people abusing laxatives. Using too many laxatives can cause long-term diarrhea, making users lose fluid and potassium in the stool. Consequently, they may experience hypokalemia, leading to the following problems:
- Cardiac arrhythmias
- Muscle weakness
- Rhabdomyolysis- a condition where muscle tissue breaks down, leading to renal failure [3]
Hyponatremia
Hyponatremia is a condition in which the sodium levels in the bloodstream drop to a critically low level. This may happen in people with laxative abuse as these medicines cause water loss along with sodium deficiency. Low sodium levels in the blood may lead to the following issues:
- Seizures
- Fatigue
- Headaches
- Nausea or vomiting
- Confusion
- Cardiorespiratory collapse
Increased risk of urinary tract infections
Long-term laxative abuse can make a person chronically dehydrated, increasing their risk of a urinary tract infection. This is because dehydration makes urine more concentrated, which irritates and potentially injures the urethra, putting it at risk of bacterial infection. Some symptoms of a urinary tract infection include abdominal cramping, frequency of urination, blood in urine, or burning during urination.
Organ damage
Laxatives impact the working of the large intestines and other organs within the digestive tract. To overcome these effects, the organs have to work overtime to compensate. If this continues for a long time, it may cause multiorgan damage, including the following:
- Irritable bowel syndrome- a condition that causes constipation, diarrhea, or both
- Cardiovascular illness, increasing the risk of stroke or heart attack
- Hepatic or liver failure
- Acute renal failure
- Inflammation of the pancreas
Increased risk of colon cancer
Using laxatives excessively can put the colon or large intestine at risk of various complications, such as infections, distention, or abnormal enlargement. Over time, these medications can also increase the risk of acquiring colon cancer. Some studies have shown people overusing laxatives are twice as likely to develop colon cancer as the general population.
Depression and anxiety
Excessive use of laxatives can cause anxiety and depression in people. Those abusing these drugs are doing so to lose weight as they feel embarrassed about how their body looks. This thinking may take a toll on their mental health, pushing them toward anxiety and depression. Moreover, such people normally withdraw from family and friends because they fear someone might find out about their abuse.
Impaired intestinal function
In many people, long-term laxative abuse may cause the intestines to lose their normal muscle and nerve function. Consequently, they may face difficulties in evacuating stools properly, a condition called “lazy colon.” This condition depicts that a colon is unable to eliminate the waste material as efficiently as it used to, causing it to accumulate in the body for a longer time. These problems can delay bowel movements and trigger unpleasant symptoms in users, such as abdominal pain and gas.
Infections
The intestines are normally coated with a layer of mucus inside to protect against irritation. Moreover, the gut also has millions of beneficial bacteria that regulate the immune system and overall health. Overuse of laxatives strips away these protective measures, making intestines vulnerable to damage and infection.
Rectal prolapse
Experiencing long-term severe diarrhea due to laxative abuse may trigger the insides of the intestines to come out through the anal opening. This condition is called rectal prolapse and requires surgical intervention.
How to Recover from Laxative Dependency?
Treatment for laxative addiction is mainly psychological and involves addressing their psychological dependency and its association with their eating disorder. Physical dependency, on the other hand, is managed through the regulation of fluid intake and medication.
Education on Bowel Function
It may be tricky to convince a person with an eating disorder and laxative abuse to stop using this medication as most are physically and psychologically dependent on them. Their main motive in continuing laxative abuse is to reach their target body weight or to keep themselves lean and slim.
Education remains a critical tool in supporting a patient to stop their laxative abuse. Experts pay special attention to educating patients on the range of normal bowel function, i.e., three bowel movements per week. Moreover, it is imperative to make all patients realize that laxatives cannot cause weight loss as calorie absorption mostly takes place in the small intestine, whereas laxatives work in the large intestine.
Laxative Abuse Recovery
The only treatment for laxative abuse so far is complete cessation. No research confirms the benefit of following a tapering dose, as ongoing exposure to this medication causes damage to the nerves and muscles. Moreover, a dependence on this medication can also trigger constipation if it continues to be used.
Some experts suggest using polyethylene glycol as an osmotic laxative as soon as a person stops using stimulating laxatives. Some may occasionally require a glycerin suppository to regulate their bowels after stopping laxatives. The exact form of medical support can vary from one person to another depending on how their body responds to the complete cessation of laxatives.
FAQs
Can using laxatives cause weight loss?
Most experts believe that using laxatives does not cause weight loss. Laxatives mainly work on the large intestines, and by the time food reaches this area, most of its calories have already been absorbed into the bloodstream. Experts now know that most of the calorie absorption process takes place in the small intestine; hence, using or abusing laxatives is not likely to change this process. Some people may experience a flatter stomach or a loss of a few pounds as laxatives may get rid of the water and electrolytes sitting in the intestines. However, this weight comes back as soon as a person drinks.
What are the long-term side effects of abusing laxatives?
In addition to causing various health problems, depression, digestive issues, and a lack of self-confidence, laxative abuse may also cause long-term health risks. These risks can be severely damaging and irreversible and include the following
- Kidney failure
- Liver damage
- Gastrointestinal damage
- Bowel nerve damage
How long does it take for laxative abuse treatment to work?
There is no fixed time duration for every person, as each case is different. Most people experience a return to normal bowel function within several weeks of seeking treatment. However, this may vary depending on how severe their abuse is and their willingness to get better.
References
1 Roerig JL, Steffen KJ, Mitchell JE, Zunker C. Laxative abuse: epidemiology, diagnosis and management. Drugs. 2010 Aug;70:1487-503.
2 Baker, MD EH, Sandle, MD GI. Complications of laxative abuse. Annual Review of Medicine. 1996 Feb;47(1):127-34.
3 Copeland PM. Renal failure associated with laxative abuse. Psychotherapy and psychosomatics. 1994 Feb 18;62(3-4):200-2.
