Lazy Bowel Syndrome Symptoms, Causes, Treatment

What is lazy bowel syndrome?

Lazy bowel syndrome refers to an abnormally low frequency of bowel movements. The condition is also referred to as “sluggish colon”, “slow transit colon” or “slow transit constipation”. The frequency of bowel movements in the human population varies considerably. Three-times a day to three times a week is a generally accepted range for the normal frequency of bowel movements.

On the other hand, a person suffering from lazy bowel syndrome has a frequency of bowel movements that is less than two or three times a week. This is also frequently accompanied by constipation and other symptoms. According to some estimates, 15 to 30% of constipation cases are caused by slow transit constipation. Lazy bowel syndrome can occur in any age group and can affect both sexes.

However, the women and the elderly are the most affected groups. Lazy bowel syndrome has frequently been attributed to an overuse of laxatives. However, this “rebound constipation” theory has been challenged on the grounds that it is not based on compelling scientific evidence. The etiology of the condition, therefore, is not clear.

Signs and Symptoms

Lazy bowel syndrome is characterized by the following constellation of signs and symptoms:

  • Low frequency of bowel movements: Less than three bowel movements in a week is taken to be a primary diagnostic symptom of a lazy bowel. This low frequency of bowel movements usually persists over several weeks.
  • Constipation: Constipation is one of the main symptoms of lazy bowel syndrome. However, it should be noted that not all constipation cases are due to sluggish bowels. Constipation is usually classified into three sub-categories: slow transit constipation, normal transit constipation, and obstructed defecation. Slow transit constipation is characterized by reduced gut motility, whereas the other two categories of constipation have normal gut movements.
  • Painful bowel movements: Due to low motility of the gut in lazy bowel syndrome, the feces stay in the intestines for a longer time. This causes more water to be absorbed from the digested food material, resulting in dry and hard feces. As a consequence, defecation becomes a painful act.
  • Inability to strain: It is possible that the person with the lazy bowel syndrome may not be able to strain as hard as a normal person while defecating. The contractions of the gut for propelling the food down the digestive tract may not be powerful enough to result in an urge to defecate.
  • Bloated stomach: A generalized feeling of bloated stomach may result from the distention of stomach caused to slow gut motility. This might also be accompanied by pain in the kidney or lower back regions.
  • Nausea: Nausea and headaches can may also accompany the lazy bowel syndrome.
  • Incomplete defecation: Due to weak bowel movements, the act of defecation may not empty the rectum and can result in a feeling of incomplete bowel movements. This could also be accompanied by soiled underwears, especially in children.

Causes of Lazy Bowel Syndrome

The main reason for lazy bowel syndrome is slow gut motility. This dysmotility of the digestive tract can be caused by the following factors:

Chronic laxative use

Lazy bowel syndrome has frequently been attributed to a chronic overuse of laxatives, especially stimulatory laxatives that result in colonic contractions and defecation. However, this theoretical cause has been challenged in scientific studies. The data shows that most laxative use does not result in dependency and rebound constipation. However, overuse of laxatives can adversely affect people who are already dehydrated.

Eating disorders

Lazy bowel syndrome has also been associated with patients with eating disorders, such as anorexia and bulimia.

Hirschsprung’s disease

This disease is characterized by a lack of some nerve cells in the colon. The resulting megacolon cannot function properly to move the feces towards the rectum.

Inadequate hydration

Dehydration has also been associated with constipation. However, the causative link is not yet proven scientifically.

Inadequate dietary fiber

Undigested dietary fiber increases the volume of the feces, which results in the expansion and subsequent contraction of the gut. Therefore, it has been suggested that inadequate dietary intake of soluble and insoluble fiber could be a contributing factor to low gut motility and lazy bowel syndrome.

Nervous system disorders

Gut motility depends on the stimulation of the gut muscles by the enteric nervous system. Therefore, it is possible that a disorder in the autonomic enteric nervous system could result in sluggish gut motility and constipation. Studies have found that colonic contractile responses to both laxatives and neurotransmitters are impaired in the patients with low gut motility.

Abdominal Pain

Some studies have also found a decrease in the number of colonic pacemaker cells (interstitial cells of Cajal) in patients with slow transit constipation. Sometimes, the low motility of the colon is also accompanied by low motility in other parts of the digestive tract, such as esophagus, stomach, small intestine, gall bladder, and rectum. This supports the view that disorders of the autonomous nervous system in the gut may be a cause of sluggish gut motility.

Treatment for Lazy Bowel Syndrome

The treatment of lazy bowel syndrome is aimed at normalizing the frequency of bowel movements as well as aiding the act of defecation. Following are some of the treatment options that are usually prescribed:

  1. Dietary management: The first line of treatment is usually dietary and fluid management. The patient is advised to increase the daily water and fiber intake. Stool softeners may also be prescribed if constipation is particularly bothersome.
  2. Increased physical activity: The link between physical activity and bowel movements is well studied. The occurrence of lazy bowel syndrome in elderly is thought be due to lack of sufficient physical activity. Increasing the time spent on physical exercise such as running might be helpful in alleviating the symptoms of lazy bowel syndrome.
  3. Colonic stimulation through drugs: Medications that increase colonic contractions might also be prescribed to stimulate bowel activity. Examples of such pharmacological treatments include colchicine, misoprostol, erythromycin, prucalopride, and tegaserod.
  4. Surgery: When all else fails, surgical interventions are used to treat sluggish bowel movements. These surgical interventions to restore gut motility have been shown to have good long-term success rates. However, the success of these procedures cannot be predicted beforehand.

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