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How to Stop Abusing Laxatives

Reprinted from Eating Disorders Review
©2000 Gürze Books

People who abuse laxatives often find themselves in a no-win situation. They use laxatives to "feel thin," which is an immediate, positive result. Eventually, however, the exact opposite occurs. They find themselves "feeling fat" from excessive water retentionÑa delayed, negative result. Here are some steps to stop abusing laxatives:

1. Stop taking laxatives right now, and do not take any more unless your physician instructs you to do so. Remember that stimulant-type laxatives are especially harmful to the body (see the reverse side).

2. Drink at least 6 to 10 cups of water (and decaffeinated beveragesÑnot caffeinated beverages because they act like a diuretic, promoting loss of fluid) a day. Restricting your fluid intake at this time promotes dehydration and only worsens the constipation.

3. Including some physical activity in your regular daily pattern can also help to regulate your bowel function, although you should discuss the intensity and type of activity first with your health care provider or therapist. Too much or too vigorous exercise can worsen constipation, due to the effects on your metabolism and fluid balance.

4. Eat regularly. It is important that you spread the amount of food recommended to you on your meal plan across at least 3 meals a day, and to eat these meals at regular intervals.

5. Eat more foods that promote normal bowel movements. The healthiest dietary approach to promoting normal bowel function is to eat more whole-grain breads, cereals, and crackers and wheat bran or foods with wheat bran added. This dietary approach should be done in tandem with drinking more fluids. Vegetables and fruits also contribute to normal bowel function. Prunes and prune juice are not recommended because the ingredient in prunes that promotes bowel movements is actually an irritant laxative, and long-term use of prunes and prune juice can result in the same problem as long-term use of laxatives.

6. Write down the frequency of your bowel movements on a sheet of paper. If you are constipated for more than 3 days, call your physician, dietitian, or psychotherapist.

What to Expect from Laxative Withdrawal

There is no way to predict exactly how stopping laxatives will affect you. For example, the amount or length of time laxatives have been used is not an indicator of how severe the withdrawal symptoms will be. The best way to lessen the unpleasant effects of laxative withdrawal is to prepare yourself for these effects and to develop an action plan for coping in case the unpleasant side effects do occur.

Common side effects of laxative withdrawal are:

¥ constipation
¥ fluid retention
¥ feeling bloated
¥ temporary weight gain

Just reading this list, you can see that laxative withdrawal is especially difficult for people with eating disorders. You already are highly reactive to "feeling fat" and the symptoms of laxative withdrawal only worsen this feeling. To help you get through the process of laxative withdrawal, it is essential to remember that any weight gain associated with laxative withdrawal is only temporary. Symptoms of laxative withdrawal do not lead to permanent weight gain.

How long will laxative withdrawal last? This varies greatly. A few people have these symptoms for 2 days; a few others have had them for 2 to 3 months. Most people have symptoms of laxative abuse for 1 to 3 weeks after stopping laxatives.

Laxative Abuse: Myths and Medical Complications

MYTH: If you induce diarrhea with laxatives, you can prevent the absorption of food and avoid body weight gain.
FACT: Inducing diarrhea by laxatives does not significantly change the absorption of food in the body. Consequently, laxatives do not significantly prevent weight gain. What appears to be weight loss is actually dehydration or water deprivation. Laxatives work near the end of the bowel, where they primarily affect absorption of water and electrolytes (like sodium and potassium). They thus work after most of the nutrients from the food have been absorbed into the body.

MYTH: You need to use a laxative every time you feel constipated.
FACT: "Feeling" constipated does not necessarily mean that you are constipated. This is especially true of people who have problems with eating. Eating too little food or eating sporadically can result in the sensation of constipation. In this case the problem is not constipation but poor eating habits.

MYTH: When you actually are constipated, you need to use a laxative.
FACT: People who use excessive amounts of laxatives will eventually find the exact opposite happeningÑthe laxatives will cause reflex constipation.

MYTH: All laxatives are alike.
FACT: There are many different types of laxatives that are taken by mouth or as a suppository. The ones most commonly used are:

Stimulant-type laxatives, including Ex-Lax¨, Correctol¨, Senokot¨, Ducolax¨, Feen-a Mint¨, and some of the so-called herbal laxatives. Osmotic-type laxatives, including Milk of Magnesia¨.

Bulk agents, including Metamucil¨, Colace¨, and unprocessed bran. Bulk agents promote bowel movement. When bulk agents are used as directed (with large amounts of water), they donÕt have the same physical effects on the bowel as the stimulant and osmotic laxatives. However, when these bulk agents are misused, they have the same psychological consequences as regular laxatives. Misusing these agents must be discontinued.

MYTH: Laxatives, particularly over-the-counter products, are safe.
FACT: Laxative abuse can be medically dangerous. Laxative abuse is defined as (1) use of laxative for weight control, or (2) frequent use of laxatives over an extended period of time.

Medical Complications of Laxative Abuse

The medical complications of laxative abuse depend on several factors, including the type of laxatives used, the amount used, and how long they have been used. Some of the more common complications of laxative abuse follow.

Constipation. Repeated use of laxatives actually causes constipation. This may lead people to increase the dosage of the amount of laxative, which in turn only worsens the constipation problem.

Dehydration. Laxatives cause fluid loss through the intestines. Dehydration then impairs body functioning.

Electrolyte abnormalities. Many people who abuse laxatives often demonstrate electrolyte imbalances. Electrolytes such as potassium, sodium, and chloride are important to life functions. With chronic diarrhea, electrolytes are drawn out of the body through the feces. This leads to an electrolyte imbalance in the body.

Edema. As noted before, laxatives cause fluid loss. Dramatic changes or fluctuations in fluid balance confuse the bodyÕs self-regulating protective mechanisms by retaining fluid. As a result, prolonged laxative abuse frequently leads to fluid retention or edema.

Bleeding. People who abuse laxatives, especially the stimulant-type laxatives, can develop blood in their stools. Chronic blood loss associated with laxative abuse can lead to anemia.

Impaired bowel function. People who abuse stimulant-type laxatives can develop permanent impairment of bowel function.

©Eating Disorders Review, PO Box 2238, Carlsbad, CA 92018 (800)756-7533
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