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.
Bowel movements may be regular and even excessive during laxative use. However, once the laxatives are stopped then the secondary constipation may arise. It can last for days to weeks and even longer in some cases. Some people use laxative for long periods due to chronic constipation. Therefore the constipation may return once the laxatives are stopped. However, the constipation may be worse that it was prior to starting laxative use.
Causes of Sluggish Bowels
Movement through the bowels is ongoing. From the time of swallowing, the small muscles in the gut walls contract and relax in a rhythmic manner to push along food and wastes through the gut. This rhythmic movement is known as peristalsis. It continues all the way down the gastrointestinal tract to the large intestine to ensure that food and wastes are constantly moving. In the lowest parts of the gut, strong peristaltic contractions pushes out feces during a bowel movement.
With a sluggish bowel, the defecation reflexes and colonic motility are impaired and it leads to 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.
Dietary and Lifestyle
A diet that is low in fiber with insufficient water intake are some of the main dietary factors that lead to constipation. The stool lacks bulk and fluid volume for easier and faster movement through the bowels. Constipation is also more likely to occur in people who live a sedentary lifestyle, particularly among obese individuals.
Nerve and Muscles
Peristalsis is a coordinated process that requires nerves to be appropriate stimulated and for nerves to stimulate muscles to contract. If there are nerve problems then the process of movement through the bowels cannot be properly coordinated. This may be seen with a spinal cord injury or conditions like multiple sclerosis (MS) and Parkinson’s disease. Similarly if there are problems with the small muscles in the bowel walls then movement through the bowels is affected.
A blockage anywhere in the bowels will prevent the movement of food and wastes. This can result in constipation. From tumors to narrowing of the bowels, the movement through the bowels are impeded to varying degrees. Constipation may lead to fecal impaction which can further compound the problem. The feces become hard and dry and block the rectum which further prevents stool from being expelled. Sometimes these obstructions can be serious, as may be seen with malignant tumors like colorectal cancer.
Sluggish bowels is commonly seen with certain hormone-related conditions. This may be seen with an underactive thyroid gland (hypothyroidism). It can also occur as a complication of diabetes but this is more likely due to diabetes-related damage of the nerves that coordination movement through the bowels (diabetic neuropathy). Constipation may also with the hormone changes that arises during pregnancy.
Treatment for a Lazy or Sluggish Bowel
For obvious reasons, the use of laxatives and enemas to facilitate bowel movements are not advisable as it compounds the problem further. The aim is to restore normal bowel habit and not induce a bowel movement. This does not require medication but can be done with supportive measures involving dietary and lifestyle changes.
- 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).