Laxative Abuse: Symptoms, Risks, and Treatment

Laxative abuse happens when someone tries to lose weight, shed calories, or feel “empty” through the repeated use of laxatives. Laxatives are medications that are used to treat constipation. They work either by stimulating the lower intestine or by softening the stool.

However, laxatives are not effective for weight control. What’s more, laxative abuse is unsafe and can lead to a wide range of short-term and long-term health complications. 

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

Types of Laxatives and How They Work

Laxatives are typically sold over the counter (OTC, without a prescription) at pharmacies and drugstores. They may come in the form of suppositories, powders, pills, or liquids. 

These medications are used to treat constipation by loosening the bowels or stimulating the intestines. The most common types of laxatives include stimulant laxatives, bulk-forming laxatives, osmotic laxatives, and stool softeners.

Stimulant Laxatives

Stimulant laxatives include nonprescription medications like Dulcolax (bisacodyl) and Senokot (senna glycoside). Because they cause intestinal contractions and can be habit-forming, they are usually meant for short-term use. They are sometimes used to “flush out” the bowels before surgery or a medical examination.

Bulk-Forming Laxatives

Bulk-forming laxatives, such as Metamucil (psyllium) and Citrucel (methylcellulose), draw water into the stool by adding fiber. This works to soften the stool and improve digestion. While bulk-forming laxatives are sometimes considered the safest kind of laxative, they can still lead to side effects if used too frequently or in high doses.

Osmotic Laxatives

Osmotic laxatives, such as lactulose, Epsom salts (magnesium sulfate), and Milk of Magnesia (magnesium hydroxide), work by drawing water into the intestines. Like stimulant laxatives, osmotic laxatives can cause electrolyte imbalances (disturbance in the balance of sodium, potassium, and calcium in the blood) and fluid changes if abused.

Stool Softeners

Stool softeners, such as Colace (docusate), ease the passage of stool from the digestive tract by adding moisture. Like other laxatives, they should be taken with caution and only for a limited time.

Laxative Abuse and Eating Disorders

Many people who abuse laxatives have an eating disorder. The American Psychiatric Association (APA) defines eating disorders as “behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.”

Around 28.8 million Americans will experience an eating disorder over the course of their lifetime. It's estimated that 4% of people in the United States will at some time abuse laxatives in an attempt to lose weight.

Laxative abuse is most commonly associated with an eating disorder called bulimia nervosa (BN). 

People with BN “binge,” or eat a large amount of food in a short time, and “purge” by compensating for their food intake in unhealthy ways. These behaviors may include taking laxatives or diuretics (water pills), as well as fasting, exercising excessively, or self-induced vomiting. 

To meet the criteria for bulimia nervosa set out in the fifth edition of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person typically has to binge and attempt to “compensate” at least once a week for three months or more. 

Many people with this disorder also feel ashamed and out of control about food. They are often preoccupied with body image and may have low self-esteem.

Are Laxatives Safe for Weight Loss?

Laxatives are not a safe method for weight loss. Not only are they ineffective as a long-term approach to maintaining a healthy weight, but they can cause many health complications.

Some of these health complications, such as severe dehydration (a harmful loss of fluid in the body) and an increased risk of colon cancer, can be life-threatening or even fatal.

Do Laxatives Cause Weight Loss?

Some people mistakenly believe that laxatives can aid in weight loss by preventing the absorption of calories from food. But laxatives generally work by stimulating the nerves and muscles in the large intestine after calories and nutrients from food have already been absorbed in the small intestine. 

While laxatives might help someone feel “empty” in the short term, older studies show that they are ineffective as a long-term method of meaningful weight loss, particularly fat loss.

Water Weight Loss vs. Weight Loss

Using laxatives may make you feel “lighter” and less bloated at first. This is because laxatives quickly flush out waste, including water, from the colon. This water weight loss is usually minor and temporary. The pounds will return as soon as you drink fluids again—which you’ll need to do to stay healthy and hydrated.

Risks and Health Consequences of Laxative Abuse

There are many potential short-term and long-term health consequences associated with laxative abuse. These may include diarrhea, dehydration, electrolyte imbalance, chronic constipation, urinary tract infections (UTIs), damage to internal organs, colon cancer, depression, and more.

Diarrhea

Using laxatives improperly can lead to gastrointestinal discomfort, gas, loose stool, and diarrhea. Laxative abuse can also lead to related problems like rectal irritation, infections, and bleeding during bowel movements.

Severe Dehydration

Laxatives remove water and other wastes from the body, which can cause dehydration. Symptoms of dehydration include muscle weakness, dizziness, thirst, inability to urinate, dark urine, confusion, and dry mouth. In severe cases, dehydration can be life-threatening.

Electrolyte Imbalance

Chronic laxative use may disrupt the balance of electrolytes (minerals like potassium, sodium, and calcium) in the body. Over time, electrolyte imbalances can negatively affect the kidneys and heart. In some cases, electrolyte loss can be fatal.

Chronic Constipation and Laxative Dependency

Over time, laxative abuse can make constipation worse. This is because laxatives can harm the muscle tone and nerve responses in the large intestine. 

People who abuse laxatives can also develop a tolerance to the medications they take, leading them to need higher and higher doses in order to have a bowel movement.

Increased Risk of UTI

Chronic dehydration from laxative abuse can increase the risk of developing a urinary tract infection. Symptoms of a UTI may include pain or burning during urination, abdominal cramping, blood in the urine, and a frequent urge to urinate.

Damage to Internal Organs

Because laxatives, especially stimulant laxatives, affect the way the large intestine functions, they can lead to internal organ damage and related health complications when abused. These complications may include:

• Irritable bowel syndrome (a functional disorder that can have symptoms of diarrhea, constipation, or both) and other gastrointestinal problems due to complications with the large intestine
• Renal failure (kidney failure)
• Hepatic failure (liver failure)
• Pancreatitis (inflammation of the pancreas)
• Heart damage, especially from electrolyte imbalances

Increased Risk of Colon Cancer

Overuse of laxatives can result in many different colon-related complications, including distension of the colon, darkening of the colon, and colon infections. Over time, laxative abuse may even increase your risk of colon cancer.

Depression

Laxative abuse may cause symptoms of mental health conditions, such as depression or anxiety. People who misuse laxatives in an attempt to lose weight may feel ashamed of or embarrassed about their behavior. They may withdraw from friends and family because they are afraid someone will find out what they are doing.

Other Consequences

There are many other possible consequences of laxative abuse, including:

• Bloating
• Vomiting
• Fainting
• Muscle spasms 
• Abdominal pain 
• Rectal prolapse (the last portion of the colon protrudes from the anus)

Getting Help for Laxative Abuse

Abusing laxatives in an effort to lose weight is a symptom of disordered eating that can have serious negative health consequences. It’s important to seek help right away. Your primary care provider (PCP) can refer you to a psychiatrist or psychotherapist who specializes in the treatment of eating disorders.

When to See a Healthcare Provider

If you are abusing laxatives, it’s important to talk to your healthcare provider about your concerns. 

Here are some questions to ask yourself if you think you are abusing laxatives or experiencing symptoms of an eating disorder:

• In the past three months, how many times have you eaten a large amount of food in a short time?
• In the past three months, how many times have you used laxatives in an attempt to lose weight?
• Do you take laxatives more often or in higher doses than recommended?
• Do you feel shame and/or guilt about your eating habits or laxative use?
• Have friends and family noticed a change in your behavior?
• Do you feel “out of control” when it comes to your eating habits or laxative use?
• Do you frequently worry about your body image or weight?

Treatments for Laxative Abuse

If you are misusing laxatives, it’s important to stop taking them right away. If you have developed a dependency on laxatives, the following steps can help to regulate your bowel movements naturally:

• Eat high-fiber foods.
• Drink plenty of water.
• Exercise regularly.
• Eat at least three times a day at regular intervals.

Treatment for laxative abuse usually involves psychotherapy, such as dialectical behavior therapy (DBT) or cognitive behavioral therapy (CBT). In therapy, your therapist can help you identify and change your negative patterns of thinking and behavior, improve your body image and self-esteem, treat co-occurring mental health disorders, and address any underlying trauma. 

If you have physical health complications as a result of ongoing laxative abuse, you may also need to see your healthcare provider for treatment. Meanwhile, a nutritionist can help you set healthy goals in terms of your eating habits and weight.

Healthier Weight Loss Strategies

Instead of taking laxatives or other medications to lose weight, it’s safer and more effective to lose weight with healthy lifestyle changes, including:

• Cutting out sugary snacks and drinks
• Eating nutrient-dense foods, such as vegetables, fruits, and lean meats
• Limiting portion size
• Limiting alcohol intake
• Getting enough sleep
• Staying hydrated
• Exercising at least 30 minutes per day

Summary

Laxative abuse involves taking laxatives for the purpose of losing weight. It is an ineffective and dangerous method of weight loss. 

Laxatives are medications that treat constipation by loosening the stool or stimulating the intestines. Common types of laxatives are stimulant laxatives, bulk-forming laxatives, osmotic laxatives, and stool softeners. 

Many people who misuse laxatives have an eating disorder, most commonly bulimia nervosa (BN). People with BN “binge,” or eat a large amount of food in a short time, followed by engaging in unhealthy compensatory behaviors (such as using laxatives, overexercising, or vomiting) in order to “purge.” 

Laxative abuse comes with a wide range of health risks, including diarrhea, gas, dehydration, electrolyte imbalance, chronic constipation, UTIs, damage to internal organs, colon cancer, depression, vomiting, fainting, muscle spasms, rectal irritation, and more. It can be treated with psychotherapy, including cognitive-behavioral therapy (CBT).

A Word From Verywell

Laxative abuse is serious and potentially dangerous. If you are misusing laxatives in an attempt to lose weight or to look a certain way, talk to your healthcare provider. They can refer you to a provider specializing in treating eating disorders and related conditions.