Laxative Abuse: Some Basic Facts

What is laxative abuse?

Laxative abuse occurs when a person attempts to get rid of unwanted calories, lose weight, “feel
thin,” or “feel empty” through the repeated, frequent use of laxatives. Often, laxatives are misused
following eating binges, when the individual mistakenly believes that the laxatives will work to rush
food and calories through the gut and bowels before they can be absorbed. But that doesn’t really
happen. Unfortunately, laxative abuse is serious and dangerous – often resulting in a variety of
health complications and sometimes causing life-threatening conditions.
What is the laxative myth?
The belief that laxatives are effective for weight control is a myth. In fact, by the time laxatives act
on the large intestine, most foods and calories have already been absorbed by the small
intestine. Although laxatives artificially stimulate the large intestine to empty, the “weight loss”
caused by a laxative-induced bowel movement contains little actual food, fat, or calories. Instead,
laxative abuse causes the loss of water, minerals, electrolytes and indigestible fiber and wastes from
the colon. This “water weight” returns as soon as the individual drinks any fluids and the body re-
hydrates. If the chronic laxative abuser refuses to re-hydrate, she or he risks dehydration, which
further taxes the organs and which may ultimately cause death.
Health Consequences of Laxative Abuse:
 Disturbance of electrolyte and mineral balances. Sodium, potassium, magnesium, and
phosphorus are electrolytes and minerals that are present in very specific amounts necessary for
proper functioning of the nerves and muscles, including those of the colon and heart. Upsetting
this delicate balance can cause improper functioning of these vital organs.
 Severe dehydration may cause tremors, weakness, blurry vision, fainting, kidney damage, and, in
extreme cases, death. Dehydration often requires medical treatment.
 Laxative dependency occurs when the colon stops reacting to usual doses of laxatives so that
larger and larger amounts of laxatives may be needed to produce bowel movements.
 Internal organ damage may result, including stretched or “lazy” colon, colon infection, Irritable
Bowel Syndrome, and, rarely, liver damage. Chronic laxative abuse may contribute to risk of
colon cancer.

Some people mistakenly believe that laxatives can force food through the body and out before all
the calories and nutrients are absorbed. Laxatives actually work by causing water to be drawn into
the large intestine to bulk up the stool and stimulate the muscle of the large intestine to contract
and expel its contents. By the time the food residue reaches the large intestine most of the calories
and energy have already been absorbed by the small intestine. Abusing laxatives may also slow
down a person's metabolism and may prevent the absorption of some nutrients, potentially leading
to nutritional deficiencies. Therefore, weight loss associated with laxative use is "water weight," and
is only temporary. The weight is regained as soon as the person re-hydrates. Laxatives do not
contribute to sustained weight loss
 Extensive laxative abuse can cause:

 Dehydration. Dehydration can cause weakness, blurry vision, fainting, kidney damage, and (in cases
of severe dehydration) death.
 Electrolyte imbalance. Electrolytes are minerals (sodium, potassium, calcium, etc.) that are in body
fluids in very precise amounts and ratios. Electrolytes are responsible for proper functioning of
nerves and muscles. Laxative abuse can upset a person's electrolyte balance and cause improper
functioning of vital organs, like the heart!
 Laxative dependence. This is when the colon requires larger and larger doses of laxatives to
produce bowel movements. People often become so dependent on laxatives that their body loses
the ability to produce bowel movements on it's own without the aid of laxatives.

Why can't laxatives help me control my weight? After I use the bathroom, I always weigh less than
I did before.

A healthy bowel receives food residue from the stomach and small intestine. As the bowel fills, fecal
matter stimulates nerve endings, causing muscle contractions that expel the residue from the body
in a bowel movement.

Laxatives and enemas artificially stimulate nerve endings in the large bowel, which is also called the
colon. The colon is one of the last structures in the digestive tract. By the time food arrives there,
nothing is left but indigestible fiber and other non-nutritive material.

Laxatives remove lots of water from the colon as well as food residue. The scales indicate weight loss
after a laxative-induced bowel movement, but it is false weight loss. The ounces or pounds return as
the body rehydrates after liquid intake consumption. If the person refuses to drink liquids, s/he risks
dehydration which can lead to fainting spells and in some cases death.

Laxatives and enemas cannot stimulate the small intestine, the part of the GI tract where food is
digested and where nutrients and calories are absorbed. The small intestine does not even have the
kinds of nerves that occur in the colon and respond to artificial stimulation.

How can I hurt myself my continuing to use laxatives and enemas?

You can upset your electrolyte balance. Electrolytes are minerals like sodium, potassium that are
dissolved in the blood and other body fluids. They must be present in very specific amounts for
proper functioning of nerves and muscles, including the heart muscle.

Laxatives and enemas (and also vomiting) can upset this balance, resulting in muscle cramps,
tremors, spasms, irregular heartbeat, and in some cases cardiac arrest. The heart stops, and unless
the person receives immediate emergency medical treatment, s/he dies.

Laxatives and enemas (and also vomiting) remove needed fluid from the body. The resulting
dehydration can lead to tremors, weakness, blurry vision, fainting spells, kidney damage, and in
some cases death. Severe dehydration requires medical treatment. Drinking fluid may not hydrate
cells and tissues quickly enough to prevent organ damage or death.
Laxatives irritate intestinal nerve endings, which in turn stimulate muscle contractions that move the
irritant through the gut and out of the body. After a while the nerve endings no longer respond to
stimulation. The person must now take greater and greater amounts of laxatives to produce bowel
movements. S/he has become laxative dependent and without them may not have any bowel
movements at all.

Laxatives and enemas strip away protective mucus that lines the colon, leaving it vulnerable to
infection.

Enemas can stretch the colon, which over time becomes a limp sack with no muscle tone. No longer
can it generate the muscle contractions necessary to move fecal matter out of the body.

Laxatives abusers seem to have more trouble with the following problems than do nonusers:
irritable bowel syndrome (rectal pain, gas, and episodes of constipation and diarrhea) and bowel
tumors (both benign and cancerous).

Constipation is a condition of the digestive system. The sufferer has hard feces that are difficult to
expel. In most cases, this occurs because the colon has absorbed too much of the water from the
food that is in the colon. The slower the food moves through your digestive tract, the more water
the colon will absorb from food. Consequently, the feces become dry and hard.

Types of laxatives
 Foods (mainly plant-based foods)

The following foods may act as laxatives. They are more effective at preventing constipation than
treating it:

Almonds, Aloe Vera, Apples/Apple Juice, Artichokes, Bananas, Basil, Beets, Blueberry, Carob,
Chicory, Chios Mastic(gum), Cranberry, Coconut, Coffee, Cornmeal, Dandelion, Dates, Dried
apricots, Endive, Fenugreek, Figs, Flaxseed, Grapes, Kale, Liquorice, Mangos, Molasses, Oranges,
Papayas, Parsley, Peaches/Apricots, Pears, Persimmons, Pineapple, Plums, Prunes/Prune Juice,
Rhubarb, Rutabagas, Soybeans, Strawberry, Tamarind, Tangerine, Tea, Tomato, Tomato Juice,
Vanilla, Walnuts, Watercress, Winter Squash, Yams, Olive oil.

 Bulk-producing agents

These work on the small and large intestine and generally take from 12 to 72 hours to work. They
are also known as bulk-forming agents, bulking agents, and roughage. They make the stool
become bulkier and retain more water.

Examples are: Metamucil (psyllium husk), Citrucel (methylcellulose), dietary fiber, broccoli,
apples, and polycarbophil.
 Stool-softeners (surfactants)

These work in the small and large intestine and generally take from 12 to 72 hours to work. They
cause fats and water to penetrate the stool, making it easier to move down the digestive system.
After prolonged use they become much less effective. They are effective for people with
occasional constipation.

Examples are: Colace, Diocto (docusate)

 Stimulants (irritants)

These work in the colon. These work by stimulating the wave of contractions that pass along the
colon propelling the stools along. Under certain circumstances they can be dangerous. Castor oil
is sometimes more effective in achieving complete evacuation.

Example: Cascara, pholphthalein, Dulcolax (bisacodyl), Senna, Aloin (from Aloe Vera), castor oil,
bisacodyl suppository, Microlax.

Types of laxatives
The four most widely used laxatives in England are:
 osmotic laxatives which make your stools (‘poo’) softer by increasing the amount of
water in your bowels
 stimulant laxatives which speed up the movement of your bowel by stimulating the
muscles that line your digestive tract
 bulk-forming laxatives, also known as fibre supplements, work in the same way as
dietary fibre; they increase the bulk of your stools by helping your stools retain fluid
 stool softener laxatives add water to your stools to lubricate them, making them
more slippery and easier to pass

Excessive loss of gastrointestinal bicarbonate

 Diarrhoea
 Fistulae of pancreas, biliary tree or intestine
 Urinary-gastrointestinal diversion surgery
 Cholestyramine
Laxatives can cause side effects, which vary between the
different types.

For example:
 bulk-forming laxatives can cause bloating and flatulence (wind)
 stimulant laxatives can cause abdominal (tummy) pain; using them for long periods
of time can result in a weakened or 'lazy' bowel
 osmotic laxatives can cause abdominal pain, bloating and flatulence
 stool softener laxatives can cause abdominal cramps, a feeling like you are going
to be sick (nausea) and a skin rash
Make sure you stay well hydrated when taking laxatives by
drinking plenty of fluids. At least two litres (six to eight glasses) of
water a day is recommended.
Less common side effects include:
 being sick (vomiting)
 dizziness - do not drive or use tools or machinery if you feel dizzy

 passing blood out with your stools

 fainting