If you’ve ever faced the discomfort of constipation, you may have turned to laxatives for relief. These over-the-counter solutions are easily accessible and often effective in getting things moving. However, while many rely on them, particularly older adults, the long-term use of laxatives is not without its risks. Although serious complications are rare, they can occur, making it crucial to use laxatives under medical guidance when used over extended periods.
Understanding Laxative Types
Laxatives come in five main types, each with a unique mechanism of action:
- Bulk-forming laxatives: These absorb water to form a soft, bulky stool, prompting normal bowel contractions. Popular brands include Metamucil and Benefiber.
- Osmotic laxatives: These draw water into the colon to ease stool passage. Common brands are Osmolax, Actilax, and Movicol.
- Stool softeners: Products like docusate (Coloxyl) act like detergents, mixing fat and water with hard stool to soften it.
- Stimulant laxatives: These trigger bowel muscle contractions, with brands like Dulcolax, Bisalax, and Senna.
- Lubricant laxatives: Parachoc is a well-known brand that coats the bowel and softens the stool.
Starting Laxatives: Precautions and Alternatives
Before resorting to laxatives, consider dietary and lifestyle changes such as increasing fiber intake with foods like kiwifruit, corn, oats, and brown rice, drinking more water, and exercising regularly. If constipation persists, start with gentler laxatives like bulk-forming types or stool softeners, while maintaining those lifestyle changes.
Consulting a doctor before starting laxatives is advisable, especially if constipation is accompanied by symptoms like rectal bleeding, as it may indicate an underlying issue. A doctor can also assess potential interactions with other medications.
The Myth of the ‘Lazy Colon’
Concerns about laxatives causing a “lazy colon” stem from a 1960s case report of a patient using stimulant laxatives for over 40 years. The report noted reduced key cells in the colon, sparking fears of damage leading to a non-functional colon, or “cathartic colon.” However, a review of over 70 publications found no evidence of such damage linked to stimulant laxatives, suggesting earlier cases might have involved now-discontinued laxatives like podophyllin.
Further reviews highlighted the poor quality and small sample sizes of studies on stimulant laxatives, with many not accounting for confounding factors like age and medication use. Overall, no strong evidence supports the idea that chronic stimulant laxative use damages the gut.
Risks of Laxative Abuse
Laxative abuse, often linked to weight loss efforts, can lead to symptoms like diarrhea, abdominal cramps, nausea, vomiting, and weight loss. More seriously, it can disrupt electrolytes, particularly potassium, leading to muscle weakness, heart complications, and potentially fatal heart rhythm changes.
“A 2020 systematic review found laxative abuse can cause mild to severe cardiac complications.”
In addition to potassium, laxative abuse can lower calcium and magnesium levels, causing painful muscle contractions and, in severe cases, kidney damage. However, sticking to recommended doses minimizes these risks.
Mental Health Implications
Two UK studies involving around half a million participants linked regular laxative use to a higher risk of depression and dementia. The theory suggests chronic abuse may alter the microbiome-gut-brain axis, increasing susceptibility to these conditions. Given the association with eating disorders, those abusing laxatives should undergo comprehensive mental health assessments to address broader issues.
Safe Use and Conclusion
While laxatives are widely used and beneficial for chronic constipation, they can cause side effects like diarrhea and electrolyte imbalances. Long-term and excessive use should be avoided unless under medical supervision. Consulting a doctor before starting laxatives is wise, particularly for individuals with other health concerns or medication regimens.
This article is republished from The Conversation and was authored by Vincent Ho of Western Sydney University.
“Vincent Ho does not work for, consult, own shares in, or receive funding from any company or organization that would benefit from this article and has disclosed no relevant affiliations beyond their academic appointment.”
