The harmful effects of laxative abuse

Over the counter stimulant laxatives

Individuals struggling with an eating disorder, such as bulimia nervosa or anorexia nervosa, often abuse laxatives. In fact, between 10% and 60% of people with an eating disorder report laxative abuse. (2)

Common stimulant laxatives people may misuse include: (3)

• Dulcolax (bisacodyl)
• Castor oil
• Cascara sagrada
• Senokot (senna)
• Phenolphthalein

These stimulant laxatives are sold over the counter, making them widely accessible. They work by stimulating the nerves in the large intestine, which causes contractions that lead to a bowel movement. Despite the fact that people don’t need a prescription to obtain stimulant laxatives, these medications can be dangerous when abused. It is recommended laxatives only be taken on a short-term basis to relieve constipation. 

The dangers associated with misusing laxatives

Laxative abuse can have many serious implications for a person’s health. It can even lead to potentially life-threatening complications. The risks and dangers associated with laxative abuse include: (1,2,3)

• Electrolyte and mineral imbalances, leading to dysfunction of vital organs
• Irregular heartbeat
• Edema
• Severe dehydration, leading to kidney damage, fainting, blurry vision, weakness, and tremors
• Irritable bowel syndrome (IBS)
• Impaired colon function
• Colon infection
• Risk of colon cancer
• Liver damage (though this is rare)
• Blood in stool, which can cause anemia
• Rectal prolapse
• Rebound constipation, leading to compulsive use of laxatives to relieve constipation
• Tolerance to laxative effects, requiring higher amounts of laxatives to produce a bowel movement
  

If someone suddenly stops using laxatives after excessive use, they may experience acute weight gain, which may motivate continued laxative use to alleviate the bloating. (2) Once someone begins using laxatives, whether for weight loss or compensation, it can be very difficult for them to stop on their own. This is because laxatives can produce psychological and physical dependence. (3)

Misconceptions about laxative abuse

Some people may believe that using laxatives will help them lose weight or avoid calorie absorption, but this is a myth. Laxatives expel waste, water, electrolytes, and minerals from the digestive system. But they don’t prevent the absorption of food and calories. (1,3)

By the time laxatives begin taking effect, most calories have already been absorbed by the small intestine. If a person loses any weight from using a laxative, it’s due to loss of water. That weight will return as soon as they drink water or other fluids. Not rehydrating in an attempt to keep the weight off can result in severe dehydration. This can lead to organ damage and life-threatening complications. (1)

Signs of laxative abuse

Knowing the signs of laxative abuse can empower people to help their loved ones get treatment for their problem or eating disorder. Common signs of laxative abuse may include: (4,5)

• Headaches
• Lightheadedness
• Faintness
• Excessive farting
• Bloating
• Stomach cramps
• Rectal bleeding
  

As tolerance builds and someone needs larger and larger amounts of stimulant laxatives to produce a bowel movement, the risk of overdosing increases. Signs of a laxative overdose include: (5,6)

• Seizure
• Breathing difficulties
• Unable to waken
• Dizziness
• Rash
• Low blood pressure
  

A laxative overdose is a medical emergency, Anyone who suspects a laxative overdose has occurred should call 911 immediately. Don’t leave the person’s side until first responders arrive.

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Treatment for laxative abuse

First, the treatment team will attempt to determine the cause of laxative abuse, such as the presence of an eating disorder, like atypical anorexia nervosa or bulimia nervosa. (1)

The next intervention would then include stopping the use of stimulant laxatives and replacing them with a stool softener to establish normal bowel movements. Stool softeners, such as Milk of Magnesia, are much safer than stimulant laxatives. (1)

If the person is hospitalized, they will receive the appropriate medical treatment for whatever health complications they may be experiencing. For example, if they are dehydrated and have an electrolyte imbalance, then the medical team will rehydrate the patient via intravenous fluids and electrolyte replacement. Or, if they have a colon infection, the team will administer antibiotics to clear up the infection. It depends on what issues the patient is presenting with. 

If an eating disorder has been diagnosed, then the medical team will refer the patient to eating disorder treatment, once their health complications have been resolved.

Entering eating disorder treatment

Eating disorder treatment can occur in several settings, including:

• Inpatient care: Patients reside at the facility for the duration of the treatment program, where they receive a combination of interventions, such as psychotherapy, behavioral therapies, group counseling, and family therapy. This is the most intensive option, providing a high level of structure and 24/7 care.
• Outpatient care: Patients live at home while attending treatment at an outpatient facility. This option is less intensive but offers more flexibility for people who need to schedule treatment around work, school, childcare, or other responsibilities. 
• Individual therapy: Patients attend one-on-one therapy with a counselor who specializes in treating eating disorders. They may attend therapy one or two times per week, for an hour each session.
• Virtual treatment: Virtual care programs, like Within Health, offer patients an alternative to in-person eating disorder treatment by providing services via video calls and messaging. This is a great option for people experiencing geographical or scheduling barriers to care.