The Dangers of Laxatives

May 09, 2019

For millions of people, the first line of defense when it comes to constipation is usually a pill or powder of some form. Whether it be stimulants or stool softeners, you might think that these medicinal treatments are safe, since they have been used for so long. However, like many things, too much can be harmful. Especially over the long term, the use of laxatives like enemas over the long term can be very damaging to your health.

If you use laxatives, please read on to find out how dangerous this can be, and learn what alternative treatments may be safer for long-term constipation relief.

About laxatives

Laxatives come in many forms, but the goal of their use remains the same: to relieve constipation. There are six major types of laxatives that include (1,2):

  • Bulk laxatives: This type of laxative has high water-binding capacity that helps it to assist with transit in the colon (Examples: dietary fiber, psyllium, methylcellulose).
  • Osmotic agents: Some osmotic agents like saline laxatives increase the amount of water in the bowels to help move stool out of the body. Other compounds, like sugar alcohols, are not absorbed well in the body and in turn are fermented by bacteria and can have a diarrheal effect. (Examples: saline laxatives like magnesium sulfate or phosphate salts; poorly absorbed sugars like lactulose, glycerin suppositories, and sugar alcohols like sorbitol or mannitol; polyethylene glycol).
  • Stimulant laxatives: These types of laxatives work by increasing intestinal motility, prevent absorption of water and sodium, and in high doses, increase secretion of water and sodium into the colon. This in turn can help produce soft stools and increase bowel frequency if used in proper doses. However, this type of laxative is often abused. (Examples: surface-active agents like docusate and bile salts; diphenylmethane derivatives like bisacodyl; ricinoleic acid like castor oil; anthraquinones like senna or aloe).
  • Emollients: This type of laxative helps to lubricate stool and soften it to assist with excretion. (Example: mineral oil).
  • Neuromuscular agents: These agents induce muscular contraction in the intestinal tract to assist in excreting stool. (Examples: colchicine, naloxone, or naltrexone).
  • Enemas: Enemas work to help relieve constipation by inserting fluid into the colon to help distend the rectum and in turn help stool to evacuate (1). An extreme form of an enema, called a colon cleanse, is also used to try to flush stool from the body. With colon cleanses, up to 16 gallons of water, sometimes mixed with coffee or herbs, is flushed through the colon, then they sit there for a while before being removed (3).  

The effects of long-term use of laxatives

Laxatives can be effective and safe in relieving constipation when used very infrequently and in appropriate doses. However, when taken in larger doses or on a frequent basis, laxatives can become both physically and psychologically addictive (2). This addiction often comes from the belief of some people that they will lose weight if they use them, when in fact laxatives will flush water and waste from the body, not calories (2,4).

One of the dangerous effects of long-term abuse of laxatives is that the intestines will gradually lose their muscle and nerve response (2). Over time, this simply means that your intestines will lose the ability to excrete stool on their own and you may become dependent on laxatives to have bowel movements. Other harmful effects of laxative abuse include (2,4):

  • Rebound constipation: Overuse of laxatives can lead to constipation episodes, which may include trapped gas in the intestines, and can make you feel as though you need to use more and more laxatives to have a bowel movement. This can lead to continued laxative abuse, along with alternating episodes of constipation and diarrhea, and can put you at risk for harmful health effects.
  • Dehydration: If you abuse laxatives, you can lose a lot of fluid that can cause you to become dehydrated. Symptoms of dehydration may include: thirst, decreased urination, headaches, lightheadedness and weakness.
  • Electrolyte abnormalities: Electrolytes are compounds like sodium, potassium, and chloride. These compounds are readily lost in diarrhea, and therefore when you abuse laxatives, these electrolytes can become imbalanced in the body. This can be very dangerous since this imbalance can lead to weakness, irregular heartbeats, or even death.
  • Rectal prolapse or perforation:  If you overuse laxatives for a long time, this can cause the inside of the intestines to protrude through the anal opening, which usually requires surgical treatment. Rectal perforation or tear can also occur, and is especially a concern with colon cleansing (3).

Other harmful effects of laxative abuse may include internal organ damage such as colon infection, irritable bowel syndrome, increased risk of colon cancer, and in rare cases, liver damage (5). If you think you may be abusing laxatives, please see a professional like a physician, counselor, psychologist or psychiatrist, and/or registered dietitian that specializes in eating disorders to help you recover.

Alternative treatments for constipation

If you have constipation, there are other ways to help relieve it besides laxatives. The following more natural methods of relieving constipation should be attempted first. Then, if such natural methods are ineffective, medications to help produce a bowel movement may be needed.

  • Drink more water:  Dehydration is the leading cause for constipation (2). Therefore, be sure to drink at least 8 cups of fluid a day to help you rehydrate and in turn help relieve constipation (2,6).
  • Exercise more: When you move your body, you can help relieve some symptoms of constipation such as bloating and gas (6). Exercise relieves constipation by helping to promote healthy intestinal contractions (2).
  • Stretch: There are specific yoga stretches that can relieve constipation by helping relax the muscles and get things moving more smoothly.
  • Increase fiber gradually: You don’t have to load up on whole grains and veggies at every sitting. However, adding a bit to your diet each day can help your gut. Start out by adding an extra serving of fruit, veggies, or grains each day, and be sure to drink plenty of water while doing this to prevent any bloating or abdominal discomfort that could occur when first increasing your daily dose of fiber (2).
  • Consume gut-friendly compounds: Probiotics, or good bacteria, as well as coffee, are just a few compounds that can help restore balance in the gut, and in turn improve gut health (6). Coffee can also stimulate muscles in the gut to improve motility, while probiotics can also help reduce inflammation in the gut, which can prevent digestive distress.
  • Eat regularly: The act of eating can help stimulate intestinal contractions (2). Therefore, try to eat small meals and snacks throughout the day to help keep the intestines moving and in turn help relieve constipation.

Summary

When used in appropriate doses, laxatives can be helpful to some people to help relieve symptoms of constipation by helping to produce bowel movements. However, because many types of laxatives are available on grocery store shelves, one may have the impression that they cannot harm the body. But any substance consumed in excess can potentially cause harm to the body.

Laxative abuse is a dangerous condition often triggered by a desire to lose weight, even though laxatives do not flush calories from the body. Dangerous side effects of laxative abuse can cause imbalances in the body that can lead to organ damage or even death. Therefore, anyone who thinks they may be suffering from laxative abuse, or if you know someone who may be, then seek help right away.

There are many alternatives to laxatives that should be attempted first to help relieve constipation. Then, if such methods are ineffective, or if you experience symptoms such as nausea, loss of appetite, or unintentional weight loss as a result of your constipation, then please seek help from a healthcare provider to assist you in finding effective treatment(s) for your constipation.

References:

(1) Portalatin, M., & Winstead, N. (2012). “Medical management of constipation.” Clinics in colon and rectal surgery25(1), 12–19. doi:10.1055/s-0032-1301754

(2) Cornell Health (accessed April 6, 2019) “Laxative Use: What to Know.” https://health.cornell.edu/sites/health/files/pdf-library/LaxativeUse.pdf

(3) Picco, M.D., M.F. (April 26, 2018) “Healthy Lifestyle: Consumer Health: Is colon cleansing a good way to eliminate toxins from your body?” https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/colon-cleansing/faq-20058435

(4) Nordqvist, C. (reviewed by Luo, M.D., X.; last updated December 21, 2017) “Laxatives for constipation: All you need to know.” Medical News Today, https://www.medicalnewstoday.com/articles/10279.php

(5) National Eating Disorders Association (accessed April 6, 2019) “Laxative Abuse.” https://www.nationaleatingdisorders.org/learn/general-information/laxative-abuse

(6) West, H. (August 2017) “Thirteen home remedies for constipation.” Medical News Today, https://www.medicalnewstoday.com/articles/318694.php

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