Normal bowel movements vary in frequency from person to person – it is accepted that passing stool anywhere from 2 times a day to 3 times a week is the norm. The terms ‘lazy bowel’ or ‘sluggish bowel’ are commonly attributed to constipation. These terms can sometimes be misleading because not every case of constipation is due to slow gastrointestinal motility. An obstruction / constriction within the bowels and various factors (physiological, pathological and psychological) that may impair the defecation reflexes also contribute to constipation with affecting gastrointestinal motility.
Constipation can be defined by three factors :
- infrequent bowel movements with passing stool less than three times in a week
- bowel movement associated with great difficulty and straining
- passing of dry, hard feces
What is Lazy Bowel Syndrome?
Lazy bowel syndrome is a term that has been coined to describe constipation following the long term and/or excessive use of laxatives. It is a rebound effect (secondary action) of using these drugs but may also just be an exacerbation of a pre-existing problem. Lazy bowel syndrome is commonly seen in those with certain types of eating disorders, particularly anorexia nervosa and bulimia, where laxative use is seen as a means of purging and used in excess even if the person did not suffer with constipation. Subsequent cessation of laxative use reveals a severe constipation.
With a sluggish bowel, the defecation reflexes and colonic motility are impaired in constipation. This means that the stretching of the colon wall associated with distension does not elicit the reflexes that are responsible for propelling the colonic contents or relaxing the internal anal sphincter. Defecation reflexes associated with food entering the stomach or chyme in the duodenum may also not stimulate mass movements in the colon under normal circumstances.
Eventually the accumulation of fecal matter stretches the colon wall excessively. This degree of stimulation elicits the natural reflexes to promote colonic motility and defecation. The distended colon (megacolon) loses its ability to create a propulsive force of sufficient magnitude for an easy passage of feces leading to straining. At this point, the prolonged time period during which the feces remained in the colon leads to over-absorption of water from the colon. Therefore dry hard feces are eventually evacuated from the bowel with much difficulty.
In order to pass stool, a person uses laxatives to induce bowel movements which are similar to the mechanisms of osmotic and secretory diarrhea (read more on runny bowel movements). Other means include an enema or colon cleansing where the introduction of water into the rectum and distal colon leads to excessive stretching and subsequently triggers the relevant reflexes and propulsive movements seen with defecation.
Treatment for a Lazy or Sluggish Bowel
For obvious reasons, the use of laxatives and enemas are not advisable as it compounds the problem further. The aim is to restore normal bowel habit and not induce a bowel movement.
- Food. Eat several meals regularly rather than a few large meals infrequently.
- Fiber. Ensure an adequate fiber intake by eating high fiber foods.
- Fluid. Drink at least 1.5 liters of water in a day, especially during/after eating meals.
- Exercise. Regular physical activity may help with regulating bowel activity.
- Habit. Establish a good bowel habit by regularly using the toilet at specific times in a day, like in the morning upon waking or after eating breakfast (defecation reflexes).