Cornell
Health
Laxative Use
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health.cornell.edu
Phone (24/7):
607-255-5155
Fax:
607-255-0269
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Ithaca, NY
14853-3101
Laxaves are medicines that treat conspaon,
either by soening the stools or by smulang the
intesnes to push out stool/have a bowel movement.
While they can be safely used temporarily, they
can do more harm than good if used improperly or
chronically without medical guidance.
Types of laxatives
Smulant laxaves such as bisacodyl
(Dulcolax), castor oil, and senna (Senokot),
are non-prescripon "over-the-counter” (OTC)
medicaons. They smulate the nerves in the
walls of the large intesnes and cause intesnal
contracons as well as uid and electrolyte
changes. While easily accessible, they can be
dangerous if used improperly, and are the most
commonly abused laxaves. These laxaves
can be habit forming, meaning that increasingly
higher doses are needed to obtain the same
eects.
“Natural” smulant laxaves usually contain
senna. These are smulant laxaves (see above)
that happen to come from plant sources. Their
dangers are the same as those of synthec
smulant laxaves.
Non-smulant laxaves are safer if used correctly
and in appropriate doses. They include the following:
• Osmoc laxaves such as Miralax and Milk
of Magnesia work by drawing uid into the
intesnes. These are less habit-forming;
however, they can sll cause uid and
electrolyte imbalances when used incorrectly.
Some require a prescripon.
• Lubricant and emollient laxaves, such as
mineral oil or docusate (Colace), work by
soening the stool. These are generally safe to
use for a limited me.
• Bulk-forming laxaves, such as psyllium
(Metamucil), Citracel, and FiberCon, are
generally safe and also are a source of dietary
ber. When used in higher-than-recommended
doses, bulk-forming laxaves can cause
intesnal problems and block absorpon of
other nutrients.
Laxative misuse
Some people take large quanes of laxaves at one
me. Others take laxaves at their recommended
dose, but on a fairly regular basis. Most people
should rarely, if ever, require a smulant laxave,
and laxaves should never be used in higher-than-
directed doses or over long periods of me. Once
a paern has started, however, people oen nd it
very dicult to stop taking laxaves because they
become reliant on them.
Laxaves can be safely used temporarily, but can do
more harm than good if used improperly.
Impacts of laxative misuse
Conspaon and impaired intesnal funcon:
With laxave misuse, the intesnes lose muscle
and nerve response. The intesnes then become
dilated and ineecve in moving stool out on its
own. This is oen reversible, but recovery may be
a slow process.
Alternang conspaon, diarrhea, and gas:
Laxave use can result in rebound conspaon,
which may include trapped gas in the intesnes.
This can cause people to try to treat those
symptoms with more laxaves, resulng in
diarrhea and a connued cycle of laxave use.
Dehydraon: Laxave over-use can cause
diarrhea, which can result in uid loss and
dehydraon. Common symptoms include thirst,
decreased urinaon, headache, light-headedness,
diminished sweang, dry mouth, and weakness.
Electrolyte abnormalies: Electrolytes such
as sodium, potassium, and chloride are lost at
abnormally high rates when someone experiences
diarrhea. Although severe complicaons are
infrequent, they are unpredictable and can
happen to someone who misuses laxaves for
the rst me, or to someone who has misused
laxaves for years.
Blood in stool and anemia: Irritaon of the colon
can lead to blood in the stools, which in turn can
cause anemia (low iron).
Rectal prolapse: Chronic severe diarrhea caused
by laxave misuse can cause the inside of the
intesnes to protrude through the anal opening.
This condion usually requires surgical treatment.
(Over)
Steps to stop
laxative misuse
• Stop now. It is generally beer to
stop completely and quickly rather
than to try to cut down slowly.
Note: If taking higher laxave
doses than is recommended per the
medicaon label on a daily basis for
more than 3-6 months, consult with
a medical provider to discuss the best
approaches for cessaon due to risk
of electrolyte disturbances as well as
swelling due to uid retenon.
• Dispose of any laxaves you have.
• Get help. Your health care provider,
diean, and/or therapist can support
you through this process.
• Take steps to prevent possible
conspaon right away. See “How to
keep regular” below.
• Prepare to deal with the urge to use
a laxave. Laxave withdrawal refers
to symptoms people experience when
they stop laxave use. Symptoms can
last from 1-3 weeks or occasionally
longer. Symptoms can include uid
retenon, conspaon, bloang, and
temporary weight shis from water
and stool.
• Think ahead about the situaons
in which you might have the urge
to use a laxave. For some people
this occurs aer a binge, or when
they haven’t had a bowel movement
in a few days. Come up with a few
alternave plans of acon in case you
do have the urge (e.g. take a walk, or
call a friend for support).
Keeping “regular”
To prevent conspaon and avoid using
laxaves:
• Be sure to include adequate uid
every day from beverages including
water, tea, coee, juice, milk, etc.
Dehydraon is the number one cause
of conspaon.
• Increase ber in your diet, gradually.
Fiber soens stools and helps prevent
both diarrhea and conspaon. Make
sure to consume adequate uids
when increasing ber intake.
• Move your body. It helps your
intesnes get moving, too.
• Eat regularly and consistently. Have 3
meals and 2-3 snacks a day to support
normal gut function.
• Noce stooling paerns. If you go
more than 3-4 days without a bowel
movement, call your health care
provider.
Resources
The Collaborave Health and Eang
Program (CHEP) provides condenal
and interdisciplinary support for eang
and body image concerns. To schedule
an appointment, call 607-255-5155.
More informaon is available at health.
cornell.edu/CHEP:
Let’s Talk is a drop-in service that
oers informal, private consulaon
with a Cornell Health counselor. More
informaon is available at health.
cornell.edu/LetsTalk:
Body Posive Cornell (BPC) is a peer
lead group that promotes holisc
wellness pracces that increase
physical, mental, and emoonal
health using a weight-neutral, self-
empowerment model. Learn more at
health.cornell.edu/BodyPosive:
Naonal Eang Disorders Associaon:
provides informaon and referrals for
treatment across the US.
Call 800-931-2237 or visit
naonaleangdisorders.org:
health.cornell.edu
08/24