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

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

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

Key Points

  • Lazy bowel syndrome, also called slow transit constipation, is a type of functional constipation.
  • Lazy bowel syndrome is a neuromuscular disorder that slows the movement of stool through the colon.
  • Lazy bowel syndrome differs from the other type of functional constipation called outlet obstruction/dyssynergic defecation, which is related to dysfunction in the anorectal (anus and rectum) area.
  • Lazy bowel syndrome has several potential underlying causes, such as autoimmunity, chronic opioid use, and gut microbiome alteration.
  • SIBO can be both a cause and consequence of lazy bowel syndrome.
  • A strong body of research suggests probiotics are very effective for improving constipation and stool transit time, which makes them an effective treatment option for lazy bowel syndrome.
  • A low FODMAP diet has shown to improve intestinal motility and other gastrointestinal symptoms associated with lazy bowel syndrome.
  • Additional natural therapies, including peppermint oil, acupuncture, and TENS (transcutaneous electrical nerve stimulation), have also shown to be effective lazy bowel syndrome treatments.

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 typeWhole-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
    What Is Lazy Bowel Syndrome and Can You Treat It Naturally? - What%20To%20Eat%20On%20The%20Paleo%20Diet 01 L

    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:

    What Is Lazy Bowel Syndrome and Can You Treat It Naturally? - Building%20a%20Foundation%20of%20Health%20for%20Gut%20Bacteria Landscape L
    • 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 OutcomeSide EffectsStudy typeCitation
    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/safe2018 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 doses2019 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 reportedTwo non-RCT clinical trials[50, 51]
    Japanese herbal medicineHange-koboku-to (HKT) reduced bowel gas volumes, abdominal pain, indigestion, and constipation in people with functional dyspepsia.None reported2009 non-RCT clinical trial[52]
    Triphala (Ayurvedic herbal)Triphala improved stool quantity, frequency, and consistency (had safe laxative effect) in patients with constipation.  Safe2005 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, diarrhea2016 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 reported2016 non-RCT clinical trial[55]
    Chinese herbal medicine: Modified Runchang-TangRelieved 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/safe2021 SR/MA[56]
    Iberogast (herbal supplement)Iberogast improved IBS symptoms, perhaps by improving motility. Safe2004 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 tolerated2014 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.

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