You are dealing with constipation. Maybe you notice that your stools are hard to get going, that you cannot go to the toilet for days, or that you depend on laxatives. Sometimes you get the diagnosis "lazy bowel". But what does that actually mean?
How your gut is meant to work
There is supposed to be a rhythm in your gut. A wave-like movement that slowly pushes the food mass through your gut towards the rectum. We call this peristalsis. As long as this rhythm runs well, you barely notice it. But when that movement slows down, the gut contents stay in your gut longer. And you start to feel that. Your stools get going less easily and can build up.
The role of serotonin
The movement of your gut does not happen on its own. It is driven by your nervous system and depends on several factors, like substances your body makes itself and the nutrients you take in. One of those substances is serotonin.
Serotonin is often called the happy hormone, because it affects your mood. When there is a shortage of serotonin, someone can feel low or depressed.
Serotonin also plays an important role in driving your gut. When the balance is right, your gut moves the way it should. But when there is too little serotonin available, that movement can slow down and it becomes harder to pass your stools.
What can throw this off balance
There are several factors that can play a role in disrupting serotonin in your body, and with that in the constipation symptoms that can lead to the diagnosis "lazy bowel".
Stress
One of the most common factors is stress. When your body is under tension for a long time, that directly affects how your body works. It also has a negative effect on the production and balance of substances like serotonin.
Your gut flora
Your microbiome also plays an important role. Billions of bacteria live in your gut that are involved in all kinds of processes in your body. One of those processes is the production of serotonin. A large part of the serotonin your body uses is actually made in your gut.
When the balance between these bacteria gets disrupted, for example by a one-sided diet, long-term stress or the use of antibiotics, this process can run less smoothly. That leaves you with less serotonin available, which can lead to symptoms like a low mood and reduced gut movement, which is how constipation can develop.
How your body converts vitamins
The way your body converts vitamins also plays an important role here. Your body needs certain vitamins and minerals to make serotonin and switch it on. If these are missing, or if your body cannot convert them properly, this can lead to a shortage.
Your genes
There are also people whose bodies naturally do this less smoothly. Because of their genes, the body can be less efficient at converting substances like folic acid and vitamin B12. Both are needed to activate serotonin.
Depending on how strong this genetic make-up is, it is possible for someone to have symptoms from birth. Think of constipation, a low mood, or sleep problems, because serotonin also plays an important role in your sleep-wake rhythm and so in your natural body clock.
Jeroen had genetic testing done on himself. It showed that his body is less able to convert folic acid and vitamin B12. These are important substances involved in making and activating serotonin. For him this did not so much lead to constipation, but it did lead to periods when he felt very low. And sometimes even the feeling that he was utterly alone in the world, without any clear reason for it.
Why your symptoms keep coming back
When no clear medical cause is found for constipation, the term "lazy bowel" often gets used. But in reality that is not an explanation. It is a description of what is happening.
Your gut moves more slowly, but the question of why remains.
And that is exactly where it often goes wrong. When you are told that your gut is "lazy", the idea quickly forms that there is little you can do about it. That you have to learn to live with the symptoms and that the solutions mainly consist of fibre and laxatives.
These can help to get your stools moving, but they do not solve why your gut works more slowly. So you keep doing what works for a while, while the underlying cause stays out of sight.
So you are not solving the problem, just keeping the symptom moving.
What this means for your symptoms
What this story shows is that constipation rarely has one clear cause. It is often an interplay of factors, like stress, the make-up of your microbiome, the substances your body needs to work well, and in some cases your genes. That also means there is no single simple solution that works for everyone.
But more importantly: it means your gut is not just "lazy". There is something underlying that affects how your gut works, which is why it is not working the way it should right now.
When you start to understand that, the way you look at your symptoms changes too. You stop only chasing what makes your symptoms bearable for a while, and start looking at what your body needs to come back into balance.
In closing
Without insight into the underlying cause, people often reach for symptom relief, like laxatives, fibre or enemas. That can give temporary relief, but it changes nothing about the reason your symptoms developed.
Constipation rarely develops out of nowhere. Only when you look at what is going on underneath can you understand why your symptoms developed and what is needed to tackle them.
And maybe the most important thing: when you start working on these different factors, it is possible to turn a "lazy bowel" back into an active, well-working gut. Without staying dependent on aids to get your stools going.
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