What features should suggest surreptitious laxative ingestion?
Some patients who present with chronic diarrhea have diarrhea as a result of laxative abuse. In general, four groups of patients have this diagnosis:
- • Bulimic patients: usually adolescent or young adult women concerned about body weight or with overt eating disorders
- • Patients seeking a secondary gain: disability payments, concern or caring behavior by others
- • Munchausen syndrome: peripatetic patients who relish being diagnostic challenges; may undergo extensive testing repeatedly
- • Polle syndrome (Munchausen syndrome by proxy): dependent child or adult given laxatives by caregiver to show effectiveness as a caregiver or to gain sympathy from others; may have a history of a sibling who died with chronic diarrhea
Laxatives can be detected by chemical testing of stool or urine. The diagnosis should be confirmed before confronting the patient, and psychiatric consultation should be available to help with further management.