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Laxative abuse.

1974; BMJ; Volume: 15; Issue: 9 Linguagem: Inglês

10.1136/gut.15.9.758

1468-3288

J. H. Cummings,

Neurosurgical Procedures and Complications

Progress report Laxative abuseAmongst the patients of every gastroenterologist there is probably one, a woman, with a long history of abdominal discomfort and diarrhoea, perhaps with vomiting, weight loss, weakness, thirst, and a psychiatric illness.There may be a past history of an ill defined metabolic disorder or renal disease.Numerous investigations will have proved fruitless although a low serum potassium, a rather distensible, featureless colon on radiographs and non-specific inflammatory changes on rectal biopsy may not have been fully explained.The latest medication is of only temporary benefit and the notes become progressively thicker.This is the picture of a patient who is taking laxatives to excess and probably concealing the fact from her doctor.Abuse of laxatives to this extent is one end of a spectrum of laxative taking which is well entrenched in our culture.The association of a regular bowel habit with physical and spiritual well being has its origins in early history (katharsis from the Greek cleansing; purgo from the Latin to purify, to make clean) and continues today with immense annual sales1 2.3.Well over 200 preparations are available over the counter in chemists' shops4 with between 15 and 30 % of people aged over 60 taking more than one dose weekly5.In general these preparations are safe with few reports of their danger6"7 when taken in recommended doses.Oxyph'enisatin has proved to be an exception as it has been closely linked with the development of hepatitis and cirrhosis28' 9,10, particularly when given with dioctylsodium sulpho- succinate'1"12.Death due to laxatives is rare13'4,15 but the syndrome of chronic ill health, sometimes called, but not identical with, the cathartic colon16,17,18,19, and due to long-continued and often surreptitious over- indulgence in laxatives has been widely reported'5-51. Clinical FeaturesOver 90 % of patients suffering from this condition are women.They present most commonly with diarrhoea, weakness, abdominal pain, nausea, vomiting, and an associated psychiatric disorder.However, these presenting features may become blurred with the passing of time so that in addition there may be weight loss, abdominal distension, amenorrhoea, thirst, or oedema.A history of childhood constipation is often a significant feature33"46 and the patients are not infrequently nurses or associated with medicine in some way30'35.36.51.Although diarrhoea is the single most common complaint, they may report constipation and even go to great lengths to conceal both the diarrhoea and laxative taking from the physician37'50'51.Indeed consti- pation is often the starting point for their consumption of laxatives.However, patients who develop what the pathologist or radiologist calls a 'cathartic colon' from prolonged laxative ingestion for constipation but without these other clinical features should not be included in the syndrome of laxative abuse.The commonly associated psychiatric disorders include depression, 758on July 24, 2023 by guest.