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Laxative abuse is reported to be common among anorexic and bulimic patients. The conventional wisdom regarding this behavior is that the laxatives are used to purge the body of excess calories in an effort to lose weight
What some eating disorder counsellors do not realize, however, is that many people who have no interest in losing weight also take too many laxatives and can end up being dependent on them or losing normal bowel function. Why would someone who's not interested in losing weight abuse laxatives? Because they are chronically constipated!
A significant percentage of patients that experience chronic constipation have an underlying disease or disorder. Diseases that cause constipation include biliary tract disorders, neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum, or anus. Many medications also have side effects that include constipation (antidepressants often do), so this possibility should be considered as well.
Neurological disorders that may cause constipation include multiple sclerosis, Parkinson's disease, chronic idiopathic intestinal pseudo-obstruction, stroke, and spinal cord injuries
Metabolic and endocrine conditions include diabetes, underactive or overactive thyroid gland, and uremia.
Systemic disorders include amyloidosis, lupus, and scleroderma.
Intestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung's disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.
Colonic inertia is caused by decreased muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the left or lower (sigmoid) colon.
Pelvic floor disorders including rectocoeles, pelvic descent, and nonrelaxing puborectalis syndrome may all cause constipation.
Constipation associated with rectal bleeding or symptoms of anemia are serious symptoms that should be reported to your physician.
A person suffering from one of these chronic disorders may not realize that their constipation is caused by disease. They may think that they need to take eat more fibre, drink more water, or exercise more. If these strategies don't work, they may start taking laxatives.
Since bowel movements are a somewhat taboo subject in most social circles, the person suffering from constipation will often keep the problem to themselves, confident that the problem will go away in time. Depending on the type of laxative taken, it may or may not offer relief. If it does, it likely won't work for long, since the effectiveness of most laxatives declines with use as the body adapts to the altered body chemistry. If stronger laxatives are tried, they may also offer temporary relief, but usually only for a short period.
It should be noted that many laxatives can cause a great deal of abdominal discomfort, ranging from gassiness, to bloating and explosive diarrhea. It is unlikely that someone who is not constipated would want to take laxatives too often, since they can have nasty side effects.
If an anorexic or bulimic patient is constipated, they are usually told it is because they do not eat enough to trigger a bowel movement,or that due to abusing laxatives, normal peristalsis has ceased. This is certainly possible; however, the possibility of disease should not be dismissed outright.
In young people with mild symptoms of constipation, a medical history and physical examination may be all the physician needs to suggest successful treatment. The tests the physician performs depends on the duration and severity of the constipation, the person's age, whether or not there is blood in stools, recent changes in bowel movements, or weight loss.
The main thing to keep in mind is that constipation can be a symptom of disease, and that one should never assume that taking excessive laxatives indicates an eating disorder. Diagnostic testing for underlying medical causes of constipation should be performed before any mental illness is suspected.
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