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What Is Lazy Bowel Syndrome and Can You Treat It Naturally?

Written by Dr. Michael Ruscio, DC on March 12, 2022

Written by Dr. Michael Ruscio, DC on March 12, 2022 — Reviewed by Dr. Hannah Hamlin

How Probiotics and Other Natural Therapies Can Get Your Gut Back on Schedule

• Lazy Bowel Syndrome Basics|
• What Causes Lazy Bowel Syndrome?|
• Natural Treatment Guide|
• How Probiotics Can Help|

Let’s face it, routine bowel movements are important not only for quality of life but also for overall health. You can think of your stool as a vehicle for toxin removal from your body. When this vehicle stalls or moves more slowly than it should, as is the case in lazy bowel syndrome, your risk of absorbing toxins that should be exiting your body increases. The end result of this type of dysfunction, as I discuss in Healthy Gut, Healthy You, can mean inflammation, poor nutrient absorption, poor immune system function, and their downstream effects. 

When it comes to lazy bowel syndrome, there are several root causes to consider, such as use of certain medications and autoimmunity. Uncovering and addressing the root cause(s) will help to improve intestinal transit and reduce the likelihood of the above cascade of events. 

While medications may be necessary for some people, research indicates several natural treatments such as probiotics, peppermint oil, and a low FODMAP diet can be effective options for slow intestinal transit. In this article, we’ll discuss what you need to know about lazy bowel syndrome, including what it is, possible causes, and we’ll also provide a natural treatment guide to help you find relief.

What Is Lazy Bowel Syndrome?

Lazy bowel syndrome isn’t actually a medical term, but is slang for a type of functional (primary) constipation called slow transit constipation — a neuromuscular medical condition that delays the movement of stool through the colon (large intestine) 1 2 3.

Basically, the orchestra of nerves, muscles, neurotransmitters, and interstitial cells of Cajal (ICC) that normally push stool toward the rectum aren’t working properly, so stool sits and accumulates in the colon for a longer period of time than is normal 3.

Slow transit constipation differs from the other type of primary constipation, called outlet dysfunction (often caused by dysfunction in the anorectal area), and from secondary constipation, which is caused by more obvious factors like dehydration, metabolic issues, medications, neurological conditions, muscular disease, and structural disorders 3.

Lazy bowel syndrome is just one type of constipation and accounts for less than 20% of constipation cases 4. It’s more common in women than men 3 and symptoms can include 2:

• Infrequent bowel movements (usually less than one per week)
• Rare or no urge to have a bowel movement
• Bloating
• Abdominal discomfort
• Painful bowel movements

Common risk factors for lazy bowel syndrome include 3:

• Being older
• Not eating enough fiber
• Long-term inactivity or immobility
• Pelvic or abdominal surgery
• Using multiple prescription medications like opioids
• Adverse childhood events and/or trauma

How Do You Know if You Have Lazy Bowel Syndrome?

Your physician or other healthcare provider will likely ask lots of questions about your bowel habits, which may not be the easiest thing to discuss, but it’s extremely important nonetheless. 

If you have at least three of the following symptoms for a period of six months or more, you may be diagnosed with lazy bowel syndrome 3:

• Less than three bowel movements per week
• Any of the following more than 25% of the time:
  • Straining with bowel movements
  • Lumpy or hard stools
  • Sensation of obstruction near the anus
  • Sensation of incomplete evacuation
  • Needing manual maneuvers (like enemas or a finger) to help with defecation

• Not having any of the secondary constipation conditions listed above

Not having any of the secondary constipation conditions listed above

Additional testing may be warranted to confirm lazy bowel syndrome or to rule out other underlying issues and may include 3:

• Digital rectal exam
• Complete blood count (CBC) and other blood tests
• Colonoscopy

And less frequently:

• Anorectal manometry (tests pressures and anorectal reflexes)
• Sitz marker study and abdominal X-ray (where markers are used to see how fast food moves through the intestines)

What Causes Lazy Bowel Syndrome?

While an exact cause is unknown, slow intestinal transit may be the result of a combination of changes in the activity of colonic nerves, muscles, or interstitial cells of Cajal (ICC), which are the pacemakers of the gastrointestinal (GI) tract.

The ICC makes up the majority of the motility apparatus of the intestine, which produces the rhythmic motion that propels food one way through the GI tract 3. Chronic constipation is associated with injury to and the loss of the ICC 5, which can be the result of an autoimmune process. For example, with Parkinson’s disease, where digestive tract nerve function is altered and results in various motility disorders such as small intestinal bacterial overgrowth (SIBO), gastroparesis, and constipation 6 7 8. But there are other non-autoimmune sources of damage to the ICC:

• Bacteria-caused acute gastroenteritis: This bacteria can create a cascade of events leading to reductions in ICC and possibly damage to the motility apparatus, with potential for SIBO 6.
• Gut microbiota: The microbes living in your digestive system are thought to affect motility and the gut-brain axis, which can lead to irritable bowel syndrome (IBS) 9 10 11.
•  IBS/SIBO: Migrating motor complex activity (the movement of undigested food through the intestinal tract during periods between meals) is lower in patients with IBS and SIBO when compared to healthy controls, and eradicating bacterial overgrowth may improve motility 12.

The good news here is that even after being damaged, the ICC can self-repair 13 14 and the neuroelectrical system in the gut can rewire itself to regain normal ICC function. This can take between six months to two years 15 16 17.

Other possible causes of lazy bowel syndrome include:

• Excessive methane produced by colon bacteria: IBS-C (IBS-constipation type) is associated with bacteria that produce methane, which can slow motility and possibly contribute to constipation 18 19.
• Chronic opioid use: This activates mu-opioid receptors in the GI tract, decreasing the movement of fecal contents toward the anus 3.
• Uncontrolled blood sugar: Contributes to inflammation that can affect gut motility 20 21.

The SIBO-Lazy Bowel Syndrome Connection

SIBO seems to be a common consequence of lazy bowel syndrome due to the disruption in gut motility 22 23. One 2011 observational study found slower digestive transit in people with diabetes when compared to healthy controls. But those with diabetes who also had SIBO had even slower transit, suggesting SIBO may result from altered intestinal motility and delayed digestive transit 24.

While SIBO can be a consequence of lazy bowel syndrome, it may also predispose someone to intestinal and systemic inflammation 25, which are contributors to slow intestinal transit. One 2015 review found patients with a positive lactulose breath test (indicating SIBO) had significantly longer colonic and whole-gut transit times 26. The table below shows the difference in intestinal transit between those with a positive vs. negative breath test:

Patient type	Whole-gut transit time (hours)
Positive lactulose breath test (24/37 patients; 65%)	70.5
Negative lactulose breath test (24/37 patients; 35%)	44.1

Lazy Bowel Syndrome Treatment Guide

If you’ve suffered from sluggish bowels for quite some time, you’ve probably tried many conventional, over-the-counter, and at-home treatments like 3:

• Increasing your dietary fiber and fluid intake
• Exercising regularly
• Training your body to go to the toilet to have a bowel movement at the same time every day
• Laxatives (psyllium, methylcellulose, polyethylene glycol, senna, or bisacodyl)
• Stool softeners like docusate
• Prescription medications

In the clinic, we tackle intestinal transit issues by first addressing diet and lifestyle changes. If your symptoms don’t measurably improve, we continue in a step-by-step fashion through other natural treatment options. 

Step 1: Diet and Lifestyle for Lazy Bowel Syndrome

While there’s no one specific diet for lazy bowel syndrome, we typically recommend getting started with a Paleo diet, which focuses on:

• Vegetables and fruits
• Meats, fish, and eggs
• Healthy fats and oils, like from avocados and olives
• Nuts and seeds

And limits:

• Grains
• Beans and legumes
• Processed foods
• Dairy products



If you try this dietary change for two to three weeks, but still struggle with bowel movements, then moving to the low FODMAP diet is a good option. 

The low FODMAP diet limits foods that encourage bacterial overgrowth. Since lazy bowel syndrome is associated with IBS and SIBO, this meal plan often leads to symptom improvement. 

One clinical trial in IBS patients found a low FODMAP diet increased the densities of endocrine cells that produce serotonin, a neurotransmitter that stimulates intestinal motility 27. Other research studies have shown the low-FODMAP diet to:

• Reduce symptoms of IBS, abdominal pain, bloating, and overall functional GI symptoms 28 29
• Improve quality of life 29

Adding kiwifruit and prunes specifically to your Paleo or low FODMAP meal plan may improve 30:

• The rate of spontaneous bowel movements
• Straining with constipation
• Stool consistency

Other lifestyle modifications to help improve symptoms of lazy bowel syndrome include:



• Exercise, which may reduce total colonic transit time and encourage proper gut contractions 31 32 33. Of course you may want to avoid overly intense exercise while you’re working on improving your gut health, which can affect gut permeability and increase inflammation.
• Restful, restorative sleep can be a challenge when you have gut issues, but poor sleep can also cause gut problems. It’s important to dial in on sleep by avoiding blue light before bed, avoiding food intake within three hours of bed, trying music therapy, and maintaining a healthy sleep routine. If sleep continues to be problematic, it’s important to discuss with your healthcare provider in order to rule out a possible sleep disorder.
• Stress management techniques such as meditation, deep breathing, or yoga. Stress can negatively affect your gut microbiota, which can worsen or even lead to digestive symptoms like constipation. 

If you’ve changed your diet and lifestyle and continue to have gut issues, move on to step 2 and add probiotics.

Step 2: Probiotics for Lazy Bowel Syndrome

Most studies have shown probiotics to improve constipation and gut motility. And probiotics have been found to be a very effective treatment for SIBO, which may be an underlying cause of your lazy bowel syndrome. In some studies, the benefits are greater than others, but they’re definitely worth a try.

Let’s take a look at some of the research on probiotics in functional constipation:

• Two systematic reviews and meta-analyses found probiotics to increase stool frequency and reduce intestinal transit by a little over 12 hours 34 35.
• A 2020 systematic review and meta-analysis found a multi-strain probiotic reduced intestinal transit by 13.75 hours, increased stool frequency, improved stool consistency, and decreased bloating 36.
• Bifidobacterium lactis may increase bowel movement frequency and improve stool consistency 35 37.
• Synbiotics (Lactobacillus plantarum, Bifidobaceterium lactis, and the prebiotic inulin — oligofructose) for 12 weeks resulted in improved bowel movement frequency and stool consistency 38.
• In chronic idiopathic constipation, probiotics in addition to a prescription medication were superior to just probiotics or other clinical interventions 39.

When looking at the research on probiotics and SIBO, research has shown clear benefits: 

• A 2017 systematic review and meta-analysis concluded probiotics are an effective treatment for SIBO, as they improve symptoms and reduce bacterial overgrowths and hydrogen concentrations 40.
• A 2010 randomized controlled trial found probiotics to be more effective at treating SIBO than a routinely used SIBO antibiotic 41.

If diet, lifestyle, and probiotics have helped, but you’ve still not achieved your desired results, you may want to move on to step 3 and investigate other natural treatments.

Step 3: Additional Natural Therapies for Lazy Bowel Syndrome

While probiotics seem to have the strongest and largest body of evidence overall for the management of constipation and stool transit time, there are a variety of additional natural options to consider:

• Peppermint oil: The essential oil of the herb peppermint has been shown in three systematic review and meta-analyses and one randomized controlled trial to improve motility, reduce inflammation, and improve the gut microbiota in patients with IBS and functional GI disorders 44 45 46 47.
• Dietary and herbal supplements: There are several supplements that have been studied with varying degrees of effectiveness. See the chart below for a synopsis of the research.

Constipation Treatment	Outcome	Side Effects	Study type	Citation
Kiwifruit extract (Zyactinase)	In people with moderate constipation, kiwifruit extract doubled bowel movement (BM) frequency from 2.5 to 5 times per week, improved stool consistency, and reduced IBS-like abdominal discomfort.	None/safe	2018 RCT	48
Magnesium (Mg)	In people with mild to moderate constipation, magnesium improved quality of life, induced more spontaneous (but not always complete) BMs, softer stools, and faster colon transit time.	Safe in normal doses	2019 RCT	49
Japanese herbal medicine	Daikenchuto (DKT) increased motilin (a hormone that stimulates gastric activity), vasoactive intestinal peptide (a hormone with vasoactive properties in the intestine), and 5-HT (serotonin).	None reported	Two non-RCT clinical trials	50 51
Japanese herbal medicine	Hange-koboku-to (HKT) reduced bowel gas volumes, abdominal pain, indigestion, and constipation in people with functional dyspepsia.	None reported	2009 non-RCT clinical trial	52
Triphala (Ayurvedic herbal)	Triphala improved stool quantity, frequency, and consistency (had safe laxative effect) in patients with constipation.	Safe	2005 non-RCT clinical trial	53
Poncirus trifoliata (bitter orange)	In those with constipation from a spinal cord injury, it relieved constipation, improved BM patterns, prevented fecal retention, and accelerated colon transit time.	Loose stool, diarrhea	2016 non-RCT clinical trial	54
Poncirus trifoliata (bitter orange)	In stroke patients with constipation, improved colonic transit time, constipation scores, and stool retention in the colon.	None reported	2016 non-RCT clinical trial	55
Chinese herbal medicine: Modified Runchang-Tang	Relieved constipation better than conventional prokinetics (a drug to enhance GI motility) and osmotic/stimulant laxatives; odds of improving functional constipation were about 4 to 1, herbs to prokinetics or laxatives.	None/safe	2021 SR/MA	56
Iberogast (herbal supplement)	Iberogast improved IBS symptoms, perhaps by improving motility.	Safe	2004 RCT	57
Inulin (a type of fermentable fiber)	Improved stool frequency, consistency, and transit time through the GI tract, but did not help with pain or bloating.	Safe/well tolerated	2014 SR/MA	58

It’s important to discuss the use of any dietary or herbal supplement with your healthcare provider.

Probiotics Can Improve Lazy Bowel Syndrome

While diet and lifestyle are extremely important foundations when it comes to lazy bowel syndrome, probiotics will likely take your treatment plan to the next level. They’ve been shown in numerous research studies to improve this type of functional constipation and they’re very safe and well-tolerated by most people. Peppermint oil, acupuncture, and TENS also seem to be very promising constipation treatments. 

If you go through the above step-by-step process and continue to have sluggish bowels, consider Healthy Gut, Healthy You, which has a more in-depth gut healing action plan. If you need a more personalized approach, we’d love to see you in the clinic at the Ruscio Institute for Functional Medicine.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

Dr. Michael Ruscio is a DC, natural health provider, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

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➕ Links & Resources

Further Reading:

• Get Your Gut Moving: Probiotics for Constipation
• SIBO, Probiotics, and Your Gut Health: A Long-Term Strategy
• The Paleo Diet: Why I Recommend It and How to Tell if It’s Right for You

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