Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

886 Laxative Abuse

Other Tests:

■Sigmoidoscopy or colonoscopy: may reveal melanosis coli, a benign

condition characterized by dark pigmentation of the mucosa caused

by anthracene-containing laxatives (senna, cascara, aloe, danthron)

■Barium enema: may reveal a cathartic colon – dilated colon with loss

of haustra, and focal areas of transient narrowing or “pseudostric-

tures”, a gaping ileoceal valve and a tubular terminal ileum

differential diagnosis

■Any condition that causes chronic diarrhea (secretory or osmotic)

management

What to Do First

■Patient should be confronted and laxatives must be stopped

General Measures

■Education re: normal bowel habits

specific therapy

■Anorexia and bulimia: psychiatric consultation

■Cathartic colon:

➣High-fiber diet and bulk laxatives

➣Enemas may help during the bowel retraining period

➣If medical therapy fails, consideration of surgery (subtotal colec-

tomy)

■Melanosis coli: no need for specific therapy; colonic changes are

reversible once laxatives stopped

follow-up

■Follow-up to assess response to medical therapy

■Some have reversal of radiographic abnormalities and function

within a few months

■Patients with melanosis coli do not need follow-up

complications and prognosis

Complications

■Laxative abuse could lead to severe electrolyte and metabolic distur-

bances serious enough to cause death

■Laxative abuse has been incriminated as the cause of melanosis coli

and cathartic colon

Prognosis

■For those able to stop laxatives, prognosis good since electrolyte and

metabolic complications are reversible