Laxative abuse syndrome.

Abstract

Laxative abuse syndrome (LAS) is a type of Münchausen syndrome characterized by surreptitious abuse of purgatives. Clinical findings are often perplexing and may mimic inflammatory bowel disease or malabsorption syndromes. Patients frequently complain of diarrhea alternating with constipation and may have nausea, vomiting and weight loss. Psychiatric disturbances are common and may include anorexia nervosa. Melanosis coli and cathartic colon, acid-base disturbances (usually metabolic alkalosis), sodium, potassium and water depletion, hyperuricemia, hyperaldosteronism and other electrolyte changes are possible complications. Diagnosis may be extremely difficult and may require special chemical analysis of urine and feces and search of the patient's possessions. Treatment is frustrating because the patient is rarely willing to admit to laxative abuse let alone cooperate in attempting to stop it. Physicians must be aware of the LAS in order to avoid harming the patient with extensive, expensive and often invasive (including laparotomy) procedures.