Laxatives are a common over-the-counter medication often used to treat constipation. However, when misused, this can lead to laxative abuse. This behavior is commonly found in people with eating disorders like anorexia nervosa and bulimia nervosa and in older people who continue to use laxatives after initially starting them for constipation.
In fact, the Journal of Eating Disorders reports that up to 75% of patients with anorexia nervosa, binge-purging subtype (AN-BP), and bulimia nervosa frequently abuse laxatives with the hope of purging their food. As with other common eating disorder behaviors — such as restricting food intake, excessive exercise, or eating to the point of discomfort and vomiting — if laxative abuse continues for too long, it can cause serious health problems. According to the National Eating Disorders Association, it’s also possible to develop laxative dependency from overuse.
Here, we will go further into what laxative abuse is, what the side effects are, how to recognize laxative abuse in a loved one, and what treatments can help.
What Is Laxative Abuse?
Originally a medicine to ease constipation, laxatives can be misused as part of purging behavior to get rid of unwanted calories. There’s a belief that laxatives help to expel food before it’s absorbed, which isn’t the case.
Because of the preoccupation people with eating disorders have with food, weight gain, shape, and appearance, they take laxatives to try and control these factors. However, taking large amounts of laxatives isn’t a safe way to lose weight and can cause many health complications.
Types of Laxatives and How They Work
There are several kinds of laxatives, and they all work in different ways. Here are some of the most common types:
Stimulant: Stimulant laxatives, such as bisacodyl and sennosides, are the strongest type of laxative. They cause the bowel to contract or squeeze to make the stool move out. It’s recommended that stimulant laxatives aren’t taken for more than a few days. If taken for an extended amount of time, they can cause the bowel to lose its muscle tone and ‘forget’ how to push out a stool without assistance.
Bulk-forming: By adding soluble fiber to a stool to soften it, bulk-forming laxatives cause the stool to absorb more water. This makes stools softer and larger, which triggers the bowel to contract and move the stool out.
While bulk-forming laxatives are considered the safest type of laxative, problems can still occur if they’re overused. Some examples of this laxative include psyllium, polycarbophil, and methylcellulose.
Osmotic: Drawing more water into the large intestine (sometimes called the lower intestine), osmotic laxatives soften the stool to help move it out. Some common examples of osmotic laxatives include glycol and magnesium hydroxide solutions.
Stool softeners: Adding more moisture into the stool makes this type of laxative easier for stools to exit the body. An example of a stool softener is docusate.
Lubricant: To help the stool move out of the body, lubricant laxatives, such as glycerin suppositories, lubricate the inside of the anus, which makes stools more slippery, and, therefore, easier to pass.
Side Effects and Health Risks of Laxative Abuse
When laxatives are overused or misused, they can bring on various side effects and, in some cases, life-threatening health risks, including:
Constipation and gas: Despite laxatives originally being prescribed for constipation, overuse of this medication can lead to continuing constipation. This is because laxative misuse can result in the intestines losing muscle and nerve response and becoming unable to move a stool out — leading to laxative dependency.
Unfortunately, this becomes a vicious cycle. Increased laxative use leads to more constipation and gas in the intestines. People take more laxatives to get rid of the gas but end up causing more gas and constipation.
Dehydration: Because many laxatives work by drawing more water into the intestine to soften stools, this can lead to subnormal body water content. The symptoms of severe dehydration include less urination, headaches, light-headedness, reduced sweating, dry mouth, and weakness.
Dehydration can also lead to some psychological side effects, according to JohnNeiska Williams, a Grow Therapy licensed professional counselor. “Dehydration can lead to impaired function of the brain that causes effects on mood, and could sometimes lead to delusions, depersonalization, or derealization.”
Electrolyte imbalances: Electrolytes affect how our body works in many ways, such as the amount of water in our body, the acidity of our blood, and our muscle function. Important electrolytes include potassium, sodium, chloride, magnesium, calcium, phosphate, and bicarbonates. We lose electrolytes when we sweat, so we need to rehydrate by drinking electrolyte-based liquids.
When a person has diarrhea, electrolytes are lost at abnormally high rates, leading to weakness, irregular heartbeats, and, on rare occasions, death.
Blood in the stool: Blood in the stool, caused by colon irritation due to laxative overuse, can lead to anemia.
Impaired bowel function: Long-term laxative abuse can result in the intestines losing their muscle tone and, consequently, being unable to pass stools normally.
Rectal prolapse: When the inside of the intestines sticks out through the anal opening, this is called a rectal prolapse and can occur because of chronic, severe diarrhea caused by laxative abuse. Rectal prolapse usually requires surgical treatment.
Organ damage: Stretched or ‘lazy’ colon, colon infection, irritable bowel syndrome, and on rare occasions, liver or kidney damage, and the risk of colon cancer are all serious medical complications that can result from laxative abuse.
How to Recognize Laxative Abuse Symptoms
Many people who abuse laxatives also have an eating disorder. Therefore, you may be looking for physical, emotional, and behavioral symptoms of an eating disorder, not only in loved ones but in yourself. Some of those symptoms include, but aren’t limited to:
- Dramatic weight loss
- Evidence of binge eating
- Preoccupation with food, weight control, and how they look
- Visible fluctuations in weight
- Sleep problems
- Feeling cold all the time
- Menstrual dysfunction
- Muscle weakness
- Hard time concentrating
However, weight loss and binge eating don’t always mean an eating disorder is to blame. “The first symptom [of laxative abuse] that you may recognize or look for is weight loss or consuming lots of food but still losing weight. Many would say that it’s down to anorexia or bulimia, but laxative abuse could often be a common cause as well,” advises Williams.
If you think you or someone you know is addicted to laxatives, you may be looking for a few other symptoms. Williams says, “Dry vomiting, depression, delusions, dehydration, blurred vision, and tremors — these aren’t always signs of laxative abuse, but these physical and physiological symptoms are a good indicator that some type of bodily abuse or issue is going on as opposed to a mental one. Again, anorexia or bulimia are normally the most common to gravitate to, but people must remember not to discount laxative abuse despite the symptoms being similar.”
Treatment Options for Laxative Abuse
If you think you’re abusing laxatives, it’s important to stop immediately and to dispose of any laxatives you have instead of trying to cut down on using them gradually.
The misuse of laxatives can lead to further constipation, so if constipation occurs, several things can be done that don’t include using laxatives:
- Eat foods rich in fiber
- Drink plenty of water
- Take part in regular physical activity
- There’s such a thing as bowel training, where you try to train yourself to go to the toilet to pass a stool at the same time each day. This may help to keep you regular.
Additionally, look to speak with your healthcare professional. Michelle Coleman, a Grow Therapy licensed professional counselor, emphasizes that early detection and treatment for laxative abuse is important for physical and mental health conditions.
“If someone has concerns about their behaviors, they should seek assistance from their primary care physician or speak with a licensed mental health professional for assessment and diagnosis whenever the concerns start. A nutritionist can also help you set healthy goals in terms of eating habits,” she adds.
It’s especially important to get the help of a healthcare provider should laxative withdrawal symptoms — which can last between one and three weeks or sometimes longer — occur, and the urge to start using them again arises. Withdrawal symptoms might appear as fluid retention, constipation, bloating, and temporary weight gain.
Attending Psychotherapy
Treatments such as trauma therapy and learning dialectical behavior therapy skills can be great tools for getting to the reasons behind the laxative abuse, says Williams. “Therapy can help to explore the processes of an individual’s behavior. It can help them identify and change their negative-thinking patterns and behavior to improve issues with body dysmorphia and self-esteem, and possible underlying trauma about weight,” she says.
Getting Help With Grow Therapy
While laxative abuse can be a serious problem on its own, there may be a disordered eating problem that needs to be dealt with, too. If you recognize that you’re participating in abnormal eating habits or aren’t using laxatives in the prescribed way, it’s important to speak with a healthcare provider as soon as possible or with someone you trust. They may be able to assist you in getting the help you need so that you can protect your physical and mental health.
Grow Therapy is home to many excellent, qualified therapists specializing in eating disorders and substance abuse. Simply filter by the specialty and insurance type you’re looking for, and find the right therapist for you or your loved ones.