Thursday, 30 October 2014

Laxative use and abuse

Beat - the UK's leading eating disorder charity - recently expressed growing concern at the numbers of people admitting that they have been able to obtain unregulated amounts of laxatives in a bid to lose weight. According to the charity, over 80% of people surveyed over the last five years admitted to taking dangerous amounts of laxatives during the struggle with an eating disorder. Earlier this month, BBC Watchdog sent a group of 14-year-olds into 25 high street stores to buy stimulant laxatives. The teenagers weren't stopped or questioned by staff, despite buying a minimum of 60 tablets each time.

Laxative abuse and misuse
Currently, laxatives can be bought from supermarkets, pharmacies and other online retailers for the short-term relief of constipation. But they are commonly abused, as people mistakenly believe that the medicines will help them lose weight. Rather than helping the body expel food, fat and calories after binge-eating, laxatives just cause the loss of water, indigestible fibre, minerals and electrolytes from the bowels.

Taking laxatives every day or in large quantities can be harmful. Laxative abuse can trigger diarrhoea, intestinal obstruction (when the bowel becomes blocked), dehydration and an imbalance of salts and minerals in the body that can lead to kidney failure. It can also damage the liver and potentially damage the heart.

Even when used legitimately, laxatives aren't suitable for everyone and aren't recommended for children, unless advised by a doctor. Some types of laxatives also aren't safe if you have certain medical conditions (e.g. Crohn's or ulcerative colitis) and may interact with other medication.

Safe laxative use
If you suffer from constipation, or are prone to it, lifestyle changes may help - drinking plenty of water, eating fibre-rich foods and taking regular exercise. But according to NHS Choices, if this isn't effective, you could try bulk-forming laxatives (e.g. isphagula husk) initially. These work like fibre-rich foods in your diet by increasing the bulk of your stools (faeces), so they are easier to push out. Bulk-forming laxatives start working after about two to three days.

If your stools are still hard, you could then try an osmotic laxative (e.g. lactulose) instead - or with - a bulk-forming laxative. These make stools softer and easier to pass by increasing the amount of water in your bowels. If your stools are soft but difficult to pass, try a stimulant laxative (e.g. bisacodyl, senna) to speed up the movement of your bowels, again with or without a bulk-forming laxative.

However, if you are often constipated, despite making appropriate lifestyle changes, or laxatives aren't effective after a week, you should see your GP to discuss your symptoms.

Sales restrictions
The Medicines and Healthcare Products Regulatory Agency (MHRA) recently issued a statement saying that while most patients use laxatives safely, it's recognised that some people misuse or abuse these commonly used medicines. A review of the current patient information is taking place, with recommendations that stronger warnings should be added to the packaging and leaflets.

Beat would like to see the following restrictions on laxative sales:
1. Minimum purchase age of 16
2. Maximum pack size (suggesting blister packs of no more than 10)
3. Sales restricted to pharmacies and not sold in general retail outlets
4. Packs not displayed in self-service areas, but kept behind the sales counter
5. Warning labels on the packs informing people that 'This is not a weight loss product'.

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