Presentation:
(1) usually female
(2) vague abdominal complaints with constipation or diarrhea
(3) complaints of tiredness or lethargy
(4) complaints of symptoms secondary to hypokalemia
Diagnostic features:
(1) frequent laxative use for years
(2) an underlying psychological condition (compulsion, anorexia nervosa)
(3) denial of use, even in the face of definite evidence
(4) surreptitious consumption
Findings:
(1) dilated colon
(2) hypokalemia
(3) melanosis coli on colonoscopy
(4) stool electrolyte consistent with osmotic diuretics
(5) cathartic colon on barium enema (distended colon with loss of haustrations and pseudostrictures)
(6) chemical demonstration of purgatives in stool or urine
Differential diagnosis:
(1) Hirschsprung's disease
