Laxative Abuse in Bulimia

Contributor:  Leigh Bell, BA, writer for Eating Disorder Hope

When Molly* called me, all she could was cry. We’d been college roommates several years ago and remained close friends, so close that I wasn’t surprised she’d call me this upset. I was surprised though, when, finally able to get out words, she told me her boyfriend found in her apartment hundreds of laxatives, which she’d been abusing for years.

Hiding the Problem

Nobody knew. Not even me. The one who’d spent years in and out of eating disorder treatment? The laxative abuse had chained Molly up and now, like too many other amazing young people, was entangled in an eating disorder.

While bulimia is normally linked to self-induced vomiting, other forms of purging include overexcite and the dangerous abuse of laxatives.

Laxative abuse is a type of purging for people with bulimia, but it’s a conniving one. Instead of ridding the body of food and calories, like many think, laxatives leech the body of water, minerals, electrolytes, and indigestible wastes from the colon. Basically laxatives shed “water weight,” which immediately returns when we drink fluids and rehydrate.

But laxatives lure people in because they temporarily make the body feel lighter, “thin,” or “empty,” but after hydration, that feeling, craved by many with an eating disorder, is gone. So it’s back to the laxatives. Eventually the colon builds a tolerance to the laxatives, and it needs more laxatives to achieve a bowel movement.

This is how people, like my friend Molly, wind up taking up 30, then 40, then 50, then even more laxatives day.

Stimulant Laxatives

Most laxative abuse is done with stimulant laxatives, like Ex-Lax. These drugs work by stimulating contractions in the colon to pass stools along.

But they don’t work to lose weight. Taking laxatives for weight loss is like trying to drain a cup of water while someone is filling it up – it doesn’t work. When laxatives do finally reach the large intestine, most food and calories have already been absorbed by the small intestine.

A study compared purgers who used laxatives to those who used self-induced vomiting, and found both groups were about the same weight, however, the group that purged by vomiting ate far more food. Those using laxatives managed their weight by food restriction – not laxatives, which the researchers concluded are “relatively ineffective.”

Research links laxative abuse to more severe eating disorder symptoms, greater suicidality, and increased self-harm. Laxative abuse could itself be a form of self-harm, the research suggests.

Overuse of laxatives is abusive to the body. Constipation is common because the colon stops regularly working without laxatives; dehydration and edema occur from intestinal fluid loss. Chronic diarrhea caused by laxative abuse creates imbalances in electrolytes like potassium, sodium, and chloride, that exist in very specific amounts for nerves and muscles to work. Internal organ damage can result, and chronic laxative abuse may increase risk of colon cancer.

Quitting

People abusing laxative may have difficulty quitting them because of the constipation that normally occurs. But, they should stop immediately unless their doctor recommends otherwise.

People may consider a dietician to help with the process, and a therapist to process feelings during and after the experience.

When Molly quit the laxatives, she was so constipated. She was uncomfortable but knew it was temporary and far better than life with laxatives. And it was – she eventually stopped.

Many techniques can also remedy the discomfort.

• Drink at least 6-10 cups of water. Restricting fluid only worsens the constipation.
• Get some physical exercise each day (intensity depending on your healthcare provider’s recommendation) to help regulate bowel function.
• Eat regularly, at least three meals a day at regular intervals.
• Eat more foods that promote normal bowel movements. These include whole-grain breads; wheat bran; fruits high in fiber like apples; green vegetables; and yogurt. While you always hear prune juice for constipation, prunes actually contain an irritant laxative, and long-term use can be as problematic as long-term use of laxatives.
• Keep track of your bowel movements, and if you haven’t had one in more than three days, contact your healthcare provider.
• Another suggestion is to replace stimulant laxatives with fiber/osmotic supplements used to normalize bowel movements, like Metamucil.

*Molly is a pseudonym used to protect personal identity. 

Community Discussion – Share your thoughts here!

Have you or your loved one struggled with abusing laxatives?  What was your recovery process?  What types of treatment have been successful for you?

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About the Author:

Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders.  These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.  We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors.  If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on October 9, 2015. Published on EatingDisorderHope.com