The disease laxatives The so-called “disease laxatives” is determined, in fact, intensive and prolonged use of these drugs, usually for a phobic attitude, as we shall see, against constipation or an obsessive desire to lose weight, in which case they are often taken together, including diuretics.
The purges have certainly represented, in the history of ‘man, one of the oldest therapies and even today remains the most frequent mode of self-medication, despite the damage that can sometimes lead and whom we shall in this brief note, which is educational and informative at the same time.
But because we own the copyright for establishing a truly morbid event it is necessary that the ingestion of laxatives, cathartic or purgative (depending on the intensity of the effect) is consistent, continuous and prolonged and not only refers to a regular intake of doses in time effective of this or that drug.
The disease laxatives, understood in that sense, it is found almost exclusively in females, and may reflect in some cases a phobic – obsessive (and often compulsive), who intends to oppose an endogenous neurotic anxiety.
What are the most frequently incriminated laxatives? Generally, the phenolphthalein, the anthraquinone plant (senna) or synthesized and saline laxatives, while never in question, as determinants of disease, mucilage, mineral oils and disaccharides such as lactulose.
The pathophysiology (ie the mechanism of action) of laxatives is not yet fully known and we can only say that laxatives “contact” would act on the nervous plexuses of the intestinal wall, increasing peristalsis and the transit speed, initially, and subsequent progression to colonic atony. In the case of saline laxatives, which act to osmotic effect, this would generate a potassium and sodium depletion and hypovolemia with secondary hyperaldosteronism, which would aggravate ulteriormrnte potassium losses. In conclusion we can say that the picture would be a common exudative enteropathy, interesting small intestine and colon, with abnormal permeability of the digestive mucosa, with absorption of toxins from the colon lumen and a ‘significant hypoproteinemia.
The clinical presentation is often variable and polymorphous, represented by diarrhea, abdominal pain, anorexia and vomiting (the latter often caused by the same patient), acute manifestations of hypokalemia (in one third of cases) and amenorrhea frequently. Endoscopic examination may show melanosis rettocolica is due to absorption regular anthraquinone.
Regarding the diagnosis, such a morbid form must always be taken into consideration when you are faced with a still young woman with chronic watery diarrhea with signs of hypokalemia and ECG examination, which is confirmed by laboratory ( elettrolitemia).
Since most of the time taking laxatives is denied by the patient, to get diagnostic ascertainment is necessary to search (and possibly get to the identification) of the same substances in the stool, as you can get with the phenolphthalein and the sulfate magnesium or their metabolites in the urine, in the case instead of anthraquinone. Another data confirmation may be provided endoscopic examination (colonoscopy) and biopsy of a chronic melanosis of the colon, always in the case of an intake of anthraquinone laxatives. All ‘X-ray (barium enema) are known and a loss of haustrazioni irregularities of caliber of the colon, the ileocecal valve gaping and the disappearance of the mucosal relief.
The therapy is based on the correction of electrolyte imbalances, and of ‘any state of malnutrition. Of course, should always be reset to the treatment of constipation, if present. You do not always have good results and should often benefit from the assistance of a psychiatrist.