Bowel training or retraining refers to behavioral programs designed to help people with bowel disorders establish or reestablish control. Individuals with symptoms of inability to control bowel movements, incomplete emptying, or chronic constipation may benefit from these programs. Bowel retraining works by teaching new skills or strategies to develop a routine and predictable schedule for evacuation. This prevents constipation and decreases unpredictable elimination.
Health care professionals that are skilled in evaluating and treating bowel disorders include physicians who specialize in gastroenterology, colorectal disorders, or physical medicine and rehabilitation. Nurses who specialize in gastroenterology, rehabilitation, or enterostomal therapy are also proficient in this area.
An evaluation prior to beginning a bowel training program should include a comprehensive bowel history, which looks at past and present bowel elimination patterns, medical history, diet, and medication. It should take into consideration the effect the disorder has on a person's life, as well as his or her goals for bowel management. A physical exam may include special tests to assess the various factors involved in bowel control. A helpful tool in devising an individualized treatment program is a symptom diary that records times of voluntary and involuntary bowel movements and other symptoms related to the disorder. A food diary may be kept simultaneously. The type of food and fluid ingested helps determine the consistency of the stool.
Bowel training programs generally take these three basic principles into account:
- Improve consistency of stool.
- Establish a regular time for elimination.
- Stimulate emptying on a routine basis. Prior to initiation of a program, it is important to rule out fecal impaction. This needs to be remedied or attempts to train the bowel will be frustrated.
Normalize Stool Consistency
The optimal goal for stool consistency is a formed, soft stool. Hard stools are difficult to evacuate and leakage is more likely if stools are liquid. One should eat well-balanced, regularly timed meals that are high in fiber. Dietary fiber refers to the parts of the food that humans are unable to digest. This includes whole grains, legumes, fresh fruits, and vegetables. Fiber adds bulk to the stool, eliminates excess fluids, and promotes more frequent and regular movements. With increasing fiber it is important to drink enough fluids. If fluid intake is inadequate, the stool becomes hard because less water is retained in the large intestine. The amount of fiber and fluids necessary for optimal bowel function varies among individuals. Dietitians are experts in evaluating and adjusting diets.
Establish a Regular Time for Elimination
A bowel training program needs to occur at the same time each day. The goal is to establish a routine and predictable time for elimination. When choosing an appropriate time a person should consider his or her past pattern of bowel elimination and present lifestyle. The time should be convenient and not rushed. Planning the program after meals allows one to take advantage of the wave-like movements that propel the fecal material through the colon to the rectum, which occur 20-30 minutes after a meal.
Stimulate Emptying on a Regular Basis
A stimulus of some kind may be needed to help empty the rectum. The stimulus will vary from individual to individual. The stimulus creates peristalsis or wave-live movements of the colon. A meal or hot drink may stimulate some persons. Others may need to use suppositories, enemas or laxatives (only under the advice of a physician) or a combination of the above. One should use the least stimulus that is effective to promote evacuation.
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Adapted from IFFGD Publication: Strategies for Establishing Bowel Control by Mary K. Plummer, OTR, WI.