Lazy Bowel Syndrome · What Is It, Causes, Treatment, and More

Lazy bowel syndrome, also known as slow transit constipation (STC), is a condition characterized by the slow movement of waste through the digestive system, primarily due to reduced motility of the large intestine. It is a type of functional constipation, or constipation without a clear cause. Other types of functional constipation include normal transit constipation and defecating disorder. Normal transit constipation occurs when the digestive system operates normally and waste moves at a normal speed; however, stool may be difficult to pass. Defecating disorder is defined as the inability to evacuate contents from the rectum despite excessive straining.

The large intestine moves waste from the small intestine to the rectum through a process called peristalsis, which is characterized by rhythmic, muscular contractions of the intestinal walls, controlled by nerves of the enteric nervous system. The enteric nervous system is a part of the nervous system that controls the function of the digestive system.

Defecation disorders: It takes coordinated muscle movements in your pelvic floor to move stool out of your body. These muscles, including your anal sphincter, need to relax at the right time for you to poop comfortably. If you have this type of constipation, you may feel the urge to go but have a hard time doing it. It may be painful.

You may have this problem if you:

• Spend a lot of time on the toilet straining and pushing to move your bowels

• Use your fingers to get stool out or use enemas frequently

• Find that laxatives or fiber supplements don’t relieve your constipation

People with this type often have hemorrhoids; cracks around the anus called fissures; and hard, impacted stools. These problems need treatment because they can make it even more difficult and painful to go.

It’s not clear what brings this kind of constipation on, but it’s often treated with behavioral and relaxation training.

Lazy bowel syndrome may be caused by several factors, which can be categorized into conditions that directly cause lazy bowel syndrome and those that indirectly cause lazy bowel syndrome.

Abnormalities of the enteric nervous system may lead to reduced or blocked peristalsis, which can be a direct cause of lazy bowel syndrome. A relatively rare cause of lazy bowel syndrome is a congenital (i.e. present at birth) condition called Hirschsprung's disease, which is a condition that causes blockages in parts or all of the large intestine due to a lack of nerve cells that are needed for normal peristaltic muscle movement. Additionally, intestinal blockage (such as a tumor), damage to anal muscles, and unhealthy bowel habits (such as delaying bowel movements) may also directly impact intestinal health, leading to lazy bowel syndrome.

Lazy bowel syndrome is commonly characterized by symptoms of constipation, which is defined as having a bowel movement fewer than three times per week. Individuals with lazy bowel syndrome may also have hard stools that are difficult to pass, resulting in straining; painful bowel movements; and hemorrhoids, which are swollen veins in the lowest part of the rectum and anus.

Other symptoms of lazy bowel syndrome include abdominal bloating and/or pain, nausea, and the inability to control bowel movements, resulting in uncontrollable soiling, poor appetite, bloody stool, and diarrhea.

Lazy bowel syndrome is commonly diagnosed by a medical professional after a thorough evaluation of an individual’s signs, symptoms, and medical history. Subsequently, a physical exam to check for abnormalities of the rectum, anus, and pelvic floor muscles may also be conducted. Prior to proceeding with further diagnostic tests, a trial of dietary fiber supplementation with or without the use of laxatives may be recommended to relieve constipation. If this trial does not relieve constipation, further investigations may be conducted. 

Additional tests may be conducted to support diagnosis, such as a blood test and stool sample. Imaging techniques, such as an abdominal X-ray, ultrasound, and colonoscopy, may be conducted to detect any abnormalities of the digestive tract, such as a blockage. Specialized imaging techniques, such as barium radiographs, colon transit studies, and motility studies may also be performed in order to further study the functioning of the gastrointestinal system. For example, anorectal manometry, which is a test that measures how well the rectum and anal sphincters work together to eliminate feces, or a balloon expulson test, which is a method used to investigate defecatory disorders, may be conducted. If the results of these tests are normal and colonic transit of stool is slow, an individual may be diagnosed with STC.

Treatment of lazy bowel syndrome typically consists of a combination of lifestyle changes and medical therapies. Oftentimes, treating the underlying cause of lazy bowel syndrome, such as treating hypothyroidism, can treat lazy bowel syndrome. Regardless, many treatment options are focused on relieving chronic constipation, which directly results from lazy bowel syndrome.

Lifestyle changes may involve light exercise to enhance blood circulation through the abdomen, thereby increasing bowel motility and relieving constipation. Specific postures, such as squatting during a bowel movement, may also be trialled as a means of facilitating bowel release.

Dietary changes, such as increasing water and probiotic intake (i.e. yogurt or supplements) while limiting dairy, caffeine, and heavily processed foods may be an effective treatment for lazy bowel syndrome and chronic constipation. Evaluating and correcting fiber intake in consultation with a medical professional may also be used as treatment as too much or too little dietary fiber may contribute to lazy bowel syndrome. 

Furthermore, limiting the use of stimulant laxatives is recommended to those with lazy bowel syndrome in order to allow the gastrointestinal system to function on its own. Instead, osmotic laxatives (e.g. PEG 3350, glycerin suppositories, and enemas) may be used as a means of stimulating a bowel movement. The duration and frequency of use of these laxatives must be advised by a medical professional.

Bowel retraining, which attempts to restore regular bowel movements by working with the body’s natural rhythms, may also be trialled as treatment. In very rare and extreme cases of lazy bowel syndrome, surgery may be performed to manually remove fecal matter or to install a colostomy bag, which is a plastic bag that collects fecal matter from the digestive tract through an opening in the abdominal wall. Lastly, interferential electrical stimulation, which uses painless electrical currents to increase digestion speed and improve nerve functioning in the digestive tract, may be an alternative to surgery.