Eating Disorders and Laxative Abuse

Misuse of laxatives is an incredibly common behaviour used by people experiencing eating disorders, but is often very secretive.

It’s seen as shameful thing to do and people often are embarrassed to admit that it’s something they are struggling with. I have spent long periods of time on and off with episodes of laxative dependency but with the support from my eating disorders team I have managed to stop taking them after years of abuse, and I am determined to never take one again.

The reason I am sharing this, is because I know there are others of you out there feeling ashamed and alone with this behaviour, but you’re not. So I wanted to write a post sharing a bit of information about laxative abuse and my tips for getting clean.

There are different kinds of laxatives, all of which are dangerous when used in excess, but the ones that carry the highest risk of damage are stimulant laxatives such as Dulcolax. I am a strong believer that laxatives should be sold over the counter, should only be sold in limited quantities like paracetamol, should have an age limit and should have more information about the long term consequences of misuse, but sadly they are easily accessible and warnings are scarce. I have bought hundreds and hundreds of laxatives in bulk at self service checkouts and there is absolutely nothing stopping me – or anyone else – from doing that. It’s incredibly dangerous.

The first and most important point I want to raise is that laxatives do not aid weight loss. So why, even when knowing this, do we still misuse them? What laxatives do, rather than cause you to lose weight, is cause you to lose water. Whilst rationally many of us know this, the problem is that losing water still changes the number on the scale, even if it’s artificial. However, because it is only water weight, once you re-hydrate that number goes back up, leading people to take more laxatives. And thus we get stuck and eventually can end up physically and psychologically dependent on them. Laxatives have no impact on calorie absorption because they work on your bowel and large intestine, whereas food is absorbed in the small intestine. Despite knowing this logically, many of us are so focused on that number we ignore the facts (and the risks).

Another reason people can turn to laxatives is that constipation can occur quite early on when people are experiencing symptoms of an eating disorder, especially anorexia. When there is very little food to digest, people can start to experience delayed gastric emptying, which can cause feelings of bloating. Laxatives, although offering short term relief, actually make this problem worse, because the bloating and constipation increases in the short term once you stop taking them.

So although laxatives have no impact on actual weight loss, they do come with various side effects, ranging from inconvenient to dangerous. Most people will experience things like bloating, gas, dehydration and sudden urges to use the toilet, but others may end up being incontinent. Blood in the stool and haemorrhoids are also not uncommon. However, some consequences can be much more serious: the dehydration can lead to severe electrolyte imbalances which can cause seizures and abnormal heart rhythms, both of which can lead to death. Dehydration can also cause kidney failure and UTI’s. In addition to this, long term or excessive use can lead to something called ‘lazy bowel’, in which the muscle tone of the bowel is lost and becomes dependent on laxatives to function. In very severe cases they can cause paralysis of the large intestine, which will then to be surgically removed. Many of these most severe consequences can happen very suddenly with no warning signs.

So surely, knowing all of this, it makes sense for us to just immediately stop using them, right? Well actually, for many people it’s not as straightforward as that. Our bodies do become reliant, especially if laxatives are taken in large quantities. One of the reasons people can end up taking so many a day is because after a period of time our bodies get used to the dosage they are having and therefore we have to increase the amount we take to get the same effect. There are different reasons withdrawal from laxatives is so difficult, some physiological and some psychological.

Physically, it can be very uncomfortable. Water retention can cause swelling of the ankles and feet, and bloating and constipation are likely in the short term. There is also likely to be an initial weight spike as a result of your body hanging onto all the water – this will pass, trust me. It’s not real weight. For me, it was the psychological part that made stopping them the most difficult. I relied on them not just physically, but my mind needed to experience that feeling of my body being empty, and knowing that I would see my weight increase once I stopped taking them made it very hard to do, even though I desperately wanted to.

Now my most important piece of advice for you is to seek guidance from a medical professional if you are struggling with laxative abuse, as they will be able to advise you on the best way to stop taking them depending on your individual situation. Sometimes they can be stopped immediately, tapered down gradually or switched to a less harmful laxative. The way I stopped taking them was on advice of my dietician to take one less per week than the previous week for as many weeks as it took to get to zero. This worked well for me and is the first time in years I have successfully managed to come off them after trying to do it independently several times. If you do have the support of a health care professional I would strongly recommend doing this with their guidance as it can be an incredibly difficult thing to do alone.

I have been very lucky and as it stands appears to have suffered no long term health consequences as a result of laxative abuse so I want to reassure you that it is possible to make a full recovery even after years of misuse.

With that said, if you are struggling with this please get help as soon as you possibly can!

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