This post originally appeared on VICE UK.
Shit is a fact of life. It's also a good litmus test for the wellbeing of our body's inner mechanisms. Regular, firm, a decent colour? You're doing okay. Black and tar-like? Something's probably up. Haven't dropped your kids off at the pool in days? Eat a banana, or head to the pharmacy.
Laxatives are a valuable tool for the constipation afflicted, but they can also disguise a toxic secret. For those with eating disorders, laxatives can become a crutch, an addiction, a weapon against their own bodies.
Anorexia and bulimia are, like many other mental health conditions, difficult to talk about. They're wrapped in shame, stigma and the fear of being viewed differently. But what we hear or talk about even less are the men and women bent double over the toilet having abused laxatives to the point of acute pain, purging their colon in pursuit of thinness. There are no exact stats on how many people this includes in the UK, but it has been found that most people who suffer from an eating disorder have used laxatives at some time.
For six months of my life, I was one of these people.
Having danced with anorexia for much of my early adolescence, I first discovered Dulcolax laxatives at the age of 16.
It was Christmas, the time where everyone worships at the altar of overeating, I hadn't taken a shit in maybe three days, which made me anxious to the point of losing my sleep. However hard I tried to claw the food from inside my stomach via the throat – scratching at my tonsils in the vain hope of vomiting – nothing came up. So I begged my dad to go to the pharmacy and pick something up that would help me go. And it did. A lot. Needless to say, I was hooked, and when I ran out of the stash in my parent's cupboard, I bought my own laxatives and took them every day for the six months.
During that time, I shat myself more times than I can count. I left toilets in the state of a nuclear wasteland. My stomach was apocalyptic. The cramps were devastating. I thought up dozens of excuses to sneak off and crouch on the toilet to let the rusty liquid fall from my arse. There was sweating, god-awful wind and the never-ending knowledge that I was filled with a "poison" that needed to come out.
I bought laxatives wherever I could: Boots, supermarkets, Poundland – they're readily available over the counter and carry no age limit to buy. The little yellow pills would be stashed in my wallet, or in a hole I had cut in the mattress. I counted them out on the desk in my Spanish class – I timed it perfectly, taking them ten hours before I wanted to go to the toilet, so they'd kick in in the middle of the night when nobody would hear me.
Eventually, though, my parents found out; at some point my mum realised she'd been routinely scouring a horrific toilet that didn't seem to get clean for six months. The gig was up. Truthfully, I was relieved. My parents were magnificent and helped me through therapy and back on my feet. Today, I am not dependant on laxatives.
So, from my current vantage point, I find myself asking: what was the point? Where did it come from? Why do people with eating disorders become addicted to laxatives?
Personally, I took them because I thought it was an effective purging method, that I was "clearing out" the calories before my body had the chance to absorb them, that I was absolving myself of any fat I'd consumed and avoiding dreaded weight gain. The feeling of emptiness was addictive. It started to feel necessary. I was scared not to take my trusted pills out with me in case my body clung on to what I ate. Thinking back, though, I guess the reasons were much more complex.
A medical study in the US looked at laxative abuse as a form of self-punishment, and concluded that "the self-harm and potentially anxiolytic features should not be overlooked." The abuse of laxatives can certainly neutralise the fear of weight gain and, for many – including me – the physical factors constitute a form of self-harm.
The sad truth is that, however empty or "safe" a large dose of laxatives might make you feel, their function in weight loss is largely redundant. By the time any food has reached your large intestine – where laxatives act – most calories have been absorbed by the body. What you're purging is just water, electrolytes, minerals and a load of other faecal waste.
Caitlin*, who started taking laxatives while discovering them working in a pharmacy, but has since quit, and now sees the futility in taking them. "Laxatives give you a false sense of security. You think you're losing weight, when all that's happening is you are losing water from your system and crucially it affects the balance of electrolytes which impacts your heart. Laxatives don't make you lose weight at all."
There's also the problem of tolerance that comes into play, too. The chronic laxative abuser risks damaging the natural cycle of their colon to the point where they cannot defecate without a large dosage of laxatives. Jordan, aged 25, believes laxative abuse has had a hugely adverse effect on her health. "I have a lot of problems with my digestive system and have to take medication to allow me to use the toilet," she says. "This is something from which I'll likely never recover."
The dehydration that comes with abusing laxatives can also really fuck over your organs – the loss of vital minerals such as potassium puts a huge strain on your heart, nerves and colon. Sometimes this results in hospitalisation. "Due to my laxative abuse," one girl told BBC's Watchdog, "I stripped the inside of my stomach lining. I was sent to A&E numerous times with stomach spasms and bad cramps." Now, her bowels have become lazy. As with dependence on any drug, your body sort of forgets how to function without it.
The problem is, laxatives – which, lets not make any bones about it, are powerful drugs – are incredibly easy to procure. Should pharmacists deny or at least question a girl in a school uniform if she's buying Senokot? Even if she says it's for her dad? Maybe. I was only ever questioned once: the cashier asked her manager who denied me the sale. I remember my face turning beetroot, anxiety throttling my already empty stomach as I shuffled out of the shop. Only, I was less embarrassed and more bothered that I would have to go somewhere else to get my fix.-------------------------------------
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Lindsay, aged 20, abused laxatives for seven years. She recently saw that Boots now sell the pills at 100 per packet. "Honestly, it just makes it easier," she says, explaining that supermarket cashiers are blind to the problem. "Nobody ever questioned or challenged me when I bought a number of packets," says Rebecca. From my perspective, Boots selling laxatives by the hundred raises alarm bells. It makes it far easier for those with eating disorders to endanger themselves.
So, what can actually be done?
B-eat UK, the leading national charity for eating disorders, is calling for tighter restrictions on the sale of laxatives in the UK. Specifically, they want a minimum age of 16, a maximum pack size, a strict behind-the-counter regulation and labels on packets that say, clearly: "This is not a weight loss product." But supermarkets and pharmacies have remained pretty silent on the matter. It's a shame, because restricting access might go some way to prevent the health ramifications that are a by-product of abuse.
It feels like laxative abuse is one of the last hurdles in our wider discussions about eating disorders – because, frankly, people still hold all sorts of prejudices over talking about shit. Despite the prevalence of this manifestation of eating disorders, we're still far more likely to see or hear the story of a girl or boy who had starved their way down to five stone. We're still profoundly shocked by images of skeletal, profoundly unwell young people with their ribs and clavicles almost piercing their paper-y skin, but we're almost used to seeing them. That's what we associate with the term "eating disorder".
But just because someone abusing laxatives doesn't fit this image (at the height of my laxative abuse, I was very thin, but not thin enough to shock like those images do), it doesn't mean they're not stuck in a similar cycle of abuse, physical pain, loneliness and psychological distress. With upwards of 1.5 million people in the UK thought to be suffering from an eating disorder, and a large proportion of those people likely to be abusing laxatives, it's something we need to stop sweeping under the carpet.
*Names have been changed
If you are concerned about the mental health of you or someone you know, talk to Mind on 020 22 00 60 or at their website, here.
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