Excessive use of laxatives is associated with heart problems and an increased risk of depression and dementia.
If you have ever suffered from constipation, you may have tried laxatives. They are easy to find without a prescription and generally help regulate the intestines.
Of course, many people use laxatives and some elderly people depend heavily on them to help intestinal function.
But you may have heard that it’s not a good idea to take them for long periods of time. Although serious complications resulting from chronic laxative use are rare, they can occur. Therefore, whenever possible, the prolonged use of laxatives should be guided and monitored by a doctor.
Types of laxatives
There are five main types of laxatives (all oral):
- Bulk-forming laxatives (also known as fibrous laxatives), which absorb water to form soft, bulky stools and stimulate normal contraction of intestinal muscles. Common brands include Metamucil and Benefiber.
- Osmotic laxativeswhich draw water into the colon to facilitate the passage of feces. Common brands include Osmolax, Actilax, and Movicol.
- Stool softenerssuch as docusate (brand name Coloxyl), which acts as a detergent and allows fat and water to mix with hardened stools, making them softer and easier to pass.
- Stimulant laxativeswhich trigger rhythmic contractions of the intestinal muscle. Common brands include Dulcolax, Bisalax and Senna.
- Lubricating laxativeswhich line the intestine and soften the stool. A common brand is Parachoc.
Start using laxatives
Before starting to use laxatives, you should try dietary and lifestyle changes, such as:
- Eat more fiber-rich foodssuch as kiwi, corn, oats and brown rice.
- Drink more water.
- Do more physical exercise.
But if constipation persists, you may consider using a laxative. Consider starting with gentler options, such as bulk-forming laxatives or stool softeners, and implement the diet and lifestyle changes listed above.
It is advisable consult your doctor when to start using laxatives; constipation may be a sign of something more worrying, especially if there are other symptoms, such as rectal bleeding.
Your doctor can also advise you about possible interactions between laxatives and other medications you are taking.
Do laxatives cause a “lazy colon”?
Probably not. So where does this idea come from?
A case report published in the 1960s described intestinal changes in a patient who had been using stimulant laxatives for more than 40 years.
When examining the colon, doctors noticed a reduction in the number of key cells. This has raised concerns about whether long-term use of stimulant laxatives could cause damage to the intestine, culminating in a “lazy colon” (also known as a cathartic colon). This occurs when the colon becomes an inert tube, with no real muscular function to propel the stool.
However, a subsequent review of more than 70 publications describing 240 cases of stimulant laxative abuse did not find any cases of cathartic diarrhea reported. The researchers concluded that the previous cases of cathartic diarrhea could be related to a laxative called podophyllin, which is now no longer recommended.
A review of 43 publications on the safety of stimulant laxatives found that many of the studies were of low qualitywith small samples. Confounding factors such as medications and age were often not taken into account.
The review found no solid evidence that chronic use of stimulant laxatives causes bowel damage.
That said, there are other good reasons to not taking laxatives regularly and long-term, unless recommended by a doctor who is monitoring your progress.
Gastrointestinal symptoms and electrolytes
Laxative abuse occurs when someone takes laxatives to lose weight through frequent and repeated use of these substances.
The most common symptom of laxative abuse is diarrheawhich may include abdominal cramps, nausea, vomiting and weight loss.
But laxative abuse can also unbalance the body’s electrolytes.
The main electrolyte present in feces is potassium. As the body loses more and more potassium through diarrhea, blood potassium levels may decrease.
This can lead to:
- generalized muscle weakness
- heart complications
- changes in heart rhythm
- in extreme cases, cardiac arrest, which can lead to death.
A 2020 systematic review of case reports found that laxative abuse can cause heart complications from mild to severe.
Laxative abuse can also deplete other electrolytes, such as calcium and magnesium, leading to painful muscle contractions. Occasionally, the kidneys can be seriously affected by chronic laxative abuse.
If you only take the recommended dose of laxatives, the risk of serious electrolyte complications is extremely low.
Depression, dementia and mental health
Two studies carried out in the United Kingdom, which analyzed a data set with approximately half a million participants, found that regular use of laxatives was associated with a higher risk of developing depression and dementia.
One theory is that chronic laxative abuse may alter what is known as the microbiota-gut-brain axis (the way the microbiota and brain communicate) and lead to a greater risk of conditions such as depression and dementia.
Laxative abuse is often associated with eating disordersso it is important that anyone who abuses laxatives also undergoes a comprehensive mental health assessment. You may need a plan to address the problem more broadly.
Safe when taken correctly
Laxatives are easily obtained without a prescription and are widely used in the community. They are certainly useful for treating chronic constipation.
However, they can cause side effects such as diarrhea and electrolyte imbalances. Prolonged and excessive use can cause problems.
It is always recommended to consult your doctor before starting to use laxatives, especially if you have other health problems or are taking other medications.
