Just like the hardened bowel disease mentioned in the Donguibogam, modern medicine views chronic constipation as hypofunction of the bowel. Rather than merely meaning that stool has hardened, it is understood as a complex issue where the intestines lose their ability to move on their own. Within the gut lies the enteric nervous system, often called the second brain. This system independently regulates peristalsis without direct instructions from the brain. The rhythmic, wave-like movement that propels stool forward is driven by this network.
Chronic constipation occurs when the function of the enteric nervous system declines or when intestinal muscle contractility weakens, much like an unlubricated machine that struggles to turn. In particular, slow transit constipation involves an abnormally prolonged transit time of stool through the large intestine, appearing when the contractility of the intestinal muscles is impaired or signal transmission within the enteric nervous system is disrupted. The term 'hardened bowel' aptly describes this state where autonomous movement slows down and propulsion is lost.
Furthermore, bowel health communicates directly with the brain through the gut-brain axis. Psychological factors such as stress, anxiety, and depression affect the secretion of neurotransmitters like serotonin, which regulate intestinal motility, thereby interfering with bowel movements. Many people experience abdominal discomfort and irregular bowel habits under stress, reflecting how the intestines directly perceive psychological strain.
The balance of the gut microbiota, or microbiome, is equally essential. When beneficial bacteria decline and harmful bacteria increase, the intestinal mucosa is compromised and inflammation can develop, negatively affecting intestinal motility. Substances that soften stool, such as short-chain fatty acids, are produced by these microorganisms; thus, an imbalance in the microbiome directly worsens stool consistency.
The real danger lies in dependency on laxatives. Taking stimulant laxatives over an extended period damages the enteric nervous system, progressively weakening autonomous motility. This can eventually lead to laxative-dependent constipation, where defecation becomes nearly impossible without medication. What the Donguibogam describes as hardened bowel disease parallels modern neural desertification of the enteric nerves, in which the intestines gradually lose their intrinsic function. Rather than relying solely on temporary relief, it is essential to support the intestines so they can regain healthy, natural motility on their own.
