Excessive Laxative Use

Excessive laxative use, also known as laxative abuse, is when someone when tries to lose weight by habitually using laxatives. Excessive laxative use is closely associated with an eating disorder called bulimia nervosa.

The ongoing misuse of laxatives can lead to chronic constipation, electrolyte imbalances, depression, heart problems, and an increased risk of colon cancer. Treatment typically involves psychotherapy and changes in eating habits.

Learn more about excessive laxative use, including the symptoms, causes, and treatment options.

What Is Excessive Laxative Use?

Excessive laxative use occurs when someone uses laxatives habitually, frequently, or in higher-than-recommended doses for weight loss or control. The aim of laxative abuse is to stimulate bowel movements so that foods are "purged" from the body before fat and calories can be absorbed.

People who misuse laxatives tend to show classic signs of eating disorders, such as:

• A preoccupation with thinness and body image
• Low self-esteem
• Shame and guilt about food
• Withdrawal from loved ones

Beyond the physical effects of excessive laxative use (including diarrhea, blurred vision, and fainting), people who misuse laxatives tend to be secretive about eating, often binge eating and feeling guilty about it afterward.

Excessive Laxative Use and Eating Disorders

Excessive laxative use is a feature of an eating disorder called bulimia nervosa (BN).

The American Psychiatric Association (APA) defines eating disorders as "severe and persistent disturbance in eating behaviors associated with distressing thoughts and emotions.” Studies suggest that around 28.8 million people in the United States will experience an eating disorder over the course of a lifetime. Around 5 million will misuse laxatives in an attempt to lose weight.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) issued by the APA, BN is characterized by the misuse of laxatives to "purge" after an eating binge. To meet the diagnostic criteria for BN, a person must engage in the binge-purge cycle at least once weekly for three months or more.

In addition to purging with laxatives, a person with BN may misuse diuretics ("water pills"), exercise excessively, fast regularly, or engage in self-induced vomiting. Other signs of BN include frequent trips to the bathroom or hidden stashes of food in the house.  

It is important to note people who do not have BN can also misuse laxatives. They may purge without binging to rapidly lose weight (to fit into a wedding dress, for example). Others may do so in an attempt to treat chronic constipation.

Whatever the reason, ongoing laxative misuse is highly predictive of a future eating disorder.

Do Laxatives Cause Weight Lost?

Some people mistakenly believe that laxatives prevent the absorption of calories from food. In fact, laxatives generally work by stimulating the movement of the large intestine (colon) after calories and nutrients from food have been absorbed by the small intestine. 

Laxatives can make you feel lighter because they quickly flush out waste and water from the colon. Even so, the weight loss is minor and temporary. The pounds will return as soon as you drink fluids—which you’ll need to do to stay healthy and hydrated.

According to research, extreme weight loss efforts like laxatives and diuretics do not work. Although there may be some initial loss due to purging, the gains are typically reversed with most people increasing their body mass index (BMI) over time.

Laxatives are ultimately not safe for weight loss. Not only are they ineffective in maintaining a healthy weight over the long term, but they can also cause potentially severe health complications.

Health Risks of Excessive Laxative Use

There are many short- and long-term consequences associated with excessive laxative use. These include diarrhea, dehydration, electrolyte imbalance, chronic constipation, urinary tract infections (UTIs), organ damage, an increased risk of colon cancer, and more.

Diarrhea

Using laxatives excessively can lead to gastrointestinal discomfort, gas, loose stool, and diarrhea. Laxative abuse can also cause rectal irritation, in part because watery stools overload rectal tissues with fluids. This can lead to an increased risk of infection and bleeding during bowel movements.

Severe Dehydration

Laxatives remove water and other fluids from the body which, in turn, can lead to dehydration. Symptoms of dehydration include muscle weakness, dizziness, thirst, inability to urinate, dark urine, confusion, and dry mouth. In severe cases, dehydration can lead to hypovolemic shock and death.

Electrolyte Imbalance

Excessive laxative use can disrupt the balance of electrolytes like potassium, sodium, and calcium in the body. These minerals are electrically charged and are essential to the regulation of many body functions, including the heartbeat, blood pressure, muscle movements, and digestion.

Over time, electrolyte imbalances can negatively affect how well your kidneys and heart work. In some cases, electrolyte loss can be fatal, leading to coma, seizures, and sudden cardiac arrest.

Chronic Constipation and Laxative Dependency

Over time, excessive laxative use can make constipation worse rather than better. This is because laxatives "overwork" the digestive tract, gradually reducing muscle tone and nerve signaling. This can start to slow (rather than speed) digestive muscle contractions. 

People who abuse laxatives can also develop a tolerance to the medications, leading them to need higher and higher doses to have a bowel movement. This is known as a laxative dependency (a.k.a. "laxative addiction").

Increased Risk of Urinary Tract Infections

Chronic dehydration from excessive laxative use can increase the risk of a urinary tract infection by concentrating chemicals in urine. The concentrated urine can irritate and injure the urethra (the tube through which urine exits the body), making it more vulnerable to bacterial infection.

Symptoms of a UTI may include pain or burning during urination, abdominal cramping, blood in the urine, and a frequent urge to urinate.

Organ Damage

Laxatives (especially stimulant laxatives) not only affect the way the large intestine works but also other organs that interact with the digestive tract. In order to compensate for the increased gut motility, these organs have to work overtime to keep up. In time, this can lead to organ damage and the loss of organ function.

Long-term complications of excessive laxative use include:

• Irritable bowel syndrome (a functional disorder that causes diarrhea, constipation, or both)
• Acute renal failure (kidney failure)
• Hepatic failure (liver failure)
• Pancreatitis (inflammation of the pancreas)
• Cardiovascular disease (increasing the risk of heart attack and stroke)

Increased Risk of Colon Cancer

The excessive use of laxatives can lead to many colon-related complications, including colon distension (the abnormal enlargement of the large intestine) and colon infections.

Over time, laxative abuse may even increase your risk of colon cancer. Studies have shown that the overuse of laxatives, including stimulant and osmotic laxatives, increases the risk of colon cancer by twofold.

Depression and Anxiety

Excessive laxative use is also associated with depression and anxiety. People who misuse laxatives to lose weight often feel shame or embarrassment about their behavior. They may withdraw from friends and family because they are afraid someone will find out what they are doing.

Other Consequences

Other possible consequences of excessive laxative use include:

• Abdominal pain 
• Vomiting
• Fainting
• Muscle spasms 
  
• Heart palpitations and arrhythmia
• Rectal prolapse (the protrusion of the colon from the anus)

Getting Help for Excessive Laxative Use

Even if you don't meet the strict criteria for bulimia nervosa, a 2021 study in the International Journal of Eating Disorders has found that using laxatives for weight loss is predictive of an eating disorder within five years.

Early treatment not only helps address the core emotional issues that fuel eating disorders but also prevents short- and long-term damage to your physical health. Your healthcare provider can refer you to a psychiatrist or therapist who specializes in treating eating disorders.

When to See a Healthcare Provider

It is important to be honest with yourself when exploring whether you have an eating disorder. Start by using yourself:

• Have you had one or more episodes of binge eating in the past three months?
  
• Do you take laxatives for other purposes other than the occasional treatment of constipation?
• Have you used laxatives in an attempt to lose weight?
• Do you take laxatives in higher doses than recommended?
• Do you feel shame, guilt, or embarrassment about your eating habits or laxative use?
• Do you frequently worry about your body image or weight?
• Do you try to hide your eating habits from close family and friends?
• Do you feel “out of control” when it comes to your eating habits or laxative use?

If you answer "yes" to some or all of these, you may have an eating disorder and may benefit from seeing a mental health professional.

Treatments for Excessive Laxative Use

The treatment for excessive laxative use usually involves psychotherapy, such as dialectical behavior therapy (DBT) or cognitive behavioral therapy (CBT). In therapy, your therapist can help you identify and change negative patterns of thinking and behavior, improve your body image and self-esteem, and address any underlying trauma that contributes to disordered eating. 

It is also important to stop taking laxatives. However, doing so abruptly can cause side effects like bloating, cramping, and constipation. Speak with your healthcare provider about natural ways to manage while you are in recovery.

This may include:

• Eating high-fiber foods
• Drinking plenty of water
• Exercising moderately to stimulate bowel movement
• Setting a regular eating schedule

If you have health issues related to laxative misuse, you may need to seek medical treatment from your healthcare provider or a specialist. A nutritionist can also help you set healthy goals in terms of your eating habits and weight.

Summary

Excessive laxative occurs when you take laxatives to lose or control weight. It is closely linked to an eating disorder called bulimia nervosa that involves cycles of binging and purging. Over time, laxative misuse can cause depression, chronic constipation, laxative dependency, organ damage, and an increased risk of colon cancer.

The treatment may involve your healthcare provider, a nutritionist, and a therapist or psychologist.