Laxatives have been around for over 2000 years. They are drugs meant to be taken for a short time to relieve constipation. Long-term use, especially for losing weight, can lead to serious medical problems, including damage to your intestines and electrolyte imbalance due to dehydration.
Historically, those who use laxatives are trying to ease or eliminate their constipation problems. People who use laxatives are grouped into four categories:
- Surprisingly, the largest group is individuals suffering from an eating disorder such as anorexia, bulimia, or binge eating. They aim to reduce or eliminate food so they will not gain weight. Most hope to become or remain thin.
- Older people use laxatives when constipated or are worried when they do not have a daily bowel movement. Our metabolism slows down as we age, often affecting our bowel movements.
- People engaged in certain types of athletic training, especially where a limit on one’s weight is required.
- Those who believe they are overweight and want to drop pounds easily and quickly.
Laxatives were originally referred to as cathartics or purgatives. The Ebers Papyrus from 1500 BCE (before the common era) is an Egyptian medical manuscript detailing over 700 herbal treatments for ailments, including constipation.
According to the ancient practice of Ayurvedic medicine, constipation is caused by cold and dry disturbances to the colon as in the vata constitution (one of the principle three constitutions, known as “doshas”). Treatments include eating warm foods and warm drinks, drinking plenty of water, and consuming bulking foods with plenty of fiber such as psyllium husks, fennel seeds, fruit pulp, and oils like ghee (a variation of clarified butter) and castor oil.
Beecham’s Pills were the first modern-day laxative produced in England around 1842. They contained ginger, aloe, and soap, acting as a mild laxative. Today there are hundreds of laxatives available as it seems everyone suffers from constipation at some time.
Most laxatives today work by helping the gut absorb more water from the body or by keeping water in the gut around the stool. This water softens the stool, making it easier to pass.
Laxatives are usually put into four or five common categories. Osmotic laxatives and stimulants in particular have intense laxative activity and can produce serious effects.
These are the gentlest on your body and safest to use. They contain fiber which absorbs water, thus making your stool softer and easier to pass. Popular are Metamucil and Citrucel and the more natural psyllium husk.
These are commonly known as stool softeners that contain surfactants that moisten the stool for better passage. They include mineral oil and glycerin suppositories.
Softening agents also moisten and soften the stool, making it easier to pass. They work well for people with hard stools, which can result from certain medications. Docusate is often recommended.
These pull water from the rest of your body into your intestines to help soften your stools. Osmotic agents contain saline products like magnesium, sulfate, potassium, or phosphate salts, and poorly absorbed sugars like lactose, sorbitol, and mannitol. Common brands are Phillips Milk of Magnesia, Miralax, and Colace.
These cause the muscles in your intestine to contract, squeezing your stool, so it moves along more rapidly. Examples include Dulcolax, castor oil, and plants such as senna (Senokot), aloe, and rhubarb.
Many natural laxatives can be just as effective in preventing constipation, often without the side effects of pharmaceutical products. Most of these are types of fiber that focus on improving the bulk of the stool for better elimination.
There are two types of fiber: soluble absorbs water and insoluble, which do not absorb water but increase the bulk of the stool so it moves better through the intestines. Make sure you drink plenty of water when using any of the following:
The primary benefit of using laxatives is to ease the distress caused by constipation. Chronic constipation affects up to 20 percent of the population. As we age, constipation can become more of a challenge—especially as our metabolism slows down, which may result in the slower movement of food and waste products through our system.
Increased health problems as we age may require the use of various medications which can also cause constipation. A sedentary lifestyle can contribute to constipation, making it important to keep our bodies moving as we age. In addition to exercise, a high-fiber diet, proper water intake, and plenty of fruits can go a long way in helping reduce or eliminate constipation.
Short-term use of laxatives depends on the type of laxative and should cure your constipation within a week. Start with a mild laxative, such as a bulking agent, and follow the product directions. If you need to take a laxative longer, you should consult a health care provider before becoming dependent on it. The side effects of laxative use can be uncomfortable, including gas and bloating, dehydration, dark urine, and diarrhea.
People trying to lose weight through laxative use must also be aware of the dangers and potential medical problems this abuse can cause. Laxatives are medicines for relieving constipation. They are not recommended to reduce body fat or promote long-term weight loss. Studies have shown that using laxatives for weight loss is ineffective and cause serious medical problems.
The dangers associated with long-term laxative use are well known. Medical problems include electrolyte and acid/base changes that can involve the renal and cardiovascular systems and may become life-threatening.
Electrolytes are essential minerals and salts such as sodium, potassium, and chloride, which help maintain your body’s balance. Symptoms of this imbalance include vomiting, headaches, confusion, dizziness, and more severe problems with your heart, liver, kidneys, and intestinal function. Electrolyte imbalance can also result from laxative overuse due to dehydration from water loss.
Laxative overuse can cause loss of bowel muscle tone—bringing about a stretched or “lazy” colon, colon infection, irritable bowel syndrome, and liver damage. This weakness then makes passing stool difficult, thus causing constipation as well as diarrhea! Chronic laxative abuse may contribute to the risk of colon cancer.
How much laxative use is considered laxative abuse? Using laxatives for too long can become an addiction and is commonly found in eating disorders, defined by the American Psychiatric Association as medical illnesses marked by severe disturbances in a person’s eating behaviors.
This unhealthy obsession with food, body weight, and body image can affect a person’s emotional, mental, and physical health, causing a person to become seriously ill with potentially fatal complications.
According to the National Association of Anorexia Nervosa, eating disorders are among the deadliest mental illnesses, second only to opioid overdose. Around 28.8 million Americans will experience an eating disorder at some time throughout their life.
A study by Dennis Gibson published in the Journal of Eating Disorders, November 2021, found that laxative abuse is an eating disorder behavior seen in up to 75 percent of those with diagnoses of anorexia nervosa binge-purge type and/or bulimia nervosa. Some of these individuals “may take 50–100 stimulant laxatives daily in an attempt to achieve the desired effect.”
Although studies suggest that eating disorders are due to a combination of factors from hormones and genetics to social and psychological issues, the actual cause is not yet understood. The three most common types are:
- Binge Eating Disorder: the most common eating disorder in the United States, especially in people with severe obesity.
- Anorexia Nervosa: These people have a distorted body image and an intense fear of gaining weight. It is most common in females ages 15 to 19, with an extremely high death rate compared with other mental disorders. People with anorexia are at risk of dying from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa.
- Bulimia Nervosa: These people use strategies after binge eating to avoid weight gain. These strategies include excessive use of laxatives or diuretics and self-induced vomiting. Many people with this disorder also feel ashamed and may have low self-esteem.
Dosages and how long to take a laxative vary with the type and the medical problem you are treating. Follow instructions on the laxative label or from your doctor. For quick relief, take laxatives on an empty stomach.
For more specific instructions on properly using each type of laxative, see the information sheet from Mayo Clinic.
Laxatives are drugs and should be used accordingly. There are many inherent dangers to taking laxatives. If you trust the long history and ease of laxative use, make sure you also know the risks. Alternatives for more natural ways to address constipation are available and safer to use.
Additionally, better general public education could mean less abuse and a healthier population. Some medical practitioners advocate removing laxatives from over-the-counter and having them available only by prescription. If the increased abuse of laxatives continues, this may become a reality.