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Definition

A program of bowel retraining, Kegel exercises, or biofeedback therapy may be used by people to help improve their bowel movements.

Information

Problems that may benefit from bowel retraining include:

• Fecal incontinence, which is the loss of bowel control, causing you to pass stool unexpectedly and involuntarily. This can range from sometimes leaking a small amount of stool and passing gas, to not being able to control bowel movements.
• Severe constipation.

These problems may be caused by:

• Brain and nerve problems (such as from multiple sclerosis)
• Emotional problems
• Spinal cord damage
• Previous surgery
• Childbirth
• Overuse of laxatives

The bowel program includes several steps to help you have regular bowel movements. Most people are able to have regular bowel movements within a few weeks. Some people will need to use laxatives along with bowel retraining. Your health care provider can tell you if you need to take laxatives and which ones are safe for you.

You will need a physical exam before you start a bowel training program. This will allow your provider to find the cause of the fecal incontinence. Disorders that can be corrected such as fecal impaction or infectious diarrhea can be treated at that time. The provider will use your history of bowel habits and lifestyle as a guide for setting new bowel movement patterns.

DIET

Making the following changes to your diet will help you have regular, soft, bulky stools:

• Eat high-fiber foods such as whole-wheat grains, fresh vegetables, and beans.
• Use products containing psyllium, such as Metamucil, to add bulk to the stools.
• Try to drink 2 to 3 liters of fluid a day (unless you have a medical condition that requires you to restrict your fluid intake).

BOWEL TRAINING

You can use digital stimulation to trigger a bowel movement:

• Insert a lubricated finger into the anus. Move it in a circle until the sphincter muscle relaxes. This may take a few minutes.
• After you have done the stimulation, sit in a normal position for a bowel movement. If you are able to walk, sit on the toilet or bedside commode. If you are confined to the bed, use a bedpan. Get into as close to a sitting position as possible. If you are unable to sit, lie on your left side.
• Try to get as much privacy as you can. Some people find that reading while sitting on the toilet helps them relax.
• If you do not have a bowel movement within 20 minutes, repeat the process.
• Try to contract the muscles of the abdomen and bear down while releasing the stool. You may find it helpful to bend forward while bearing down. This increases the pressure within the abdomen and helps empty the bowel.
• Perform stimulation with your finger every day until you start to have a regular pattern of bowel movements.
• You can also stimulate bowel movements by using a suppository (glycerin or bisacodyl) or a small enema. Some people find it helpful to drink warm prune juice or fruit nectar.

Keeping to a regular pattern is very important for a bowel retraining program to succeed. Set a regular time for daily bowel movements. Choose a time that is convenient for you. Keep in mind your daily schedule. The best time for a bowel movement is 20 to 40 minutes after a meal, because eating stimulates bowel activity.

Most people are able to establish a regular routine of bowel movements within a few weeks.

KEGEL EXERCISES

Exercises to strengthen the pelvic and rectal muscles may help with bowel control in people who have incompetent anal sphincters. Kegel exercises that increase pelvic and rectal muscle tone can be used for this. These exercises were first developed to control incontinence in women after childbirth.

To be successful with Kegel exercises, use the proper technique and stick to a regular exercise program. Talk with your provider for instructions about how to do these exercises.

BIOFEEDBACK

Biofeedback gives you sound or visual feedback about a bodily function. In people with fecal incontinence, biofeedback is used to strengthen the anal sphincters.

A rectal plug is used to detect the strength of the rectal muscles. A monitoring electrode is placed on the abdomen. The rectal plug is then attached to a computer monitor. A graph displaying rectal muscle contractions and abdominal contractions will show up on the screen.

To use this method, you will be taught how to squeeze the rectal muscle around the rectal plug. The computer display guides you to make sure you are doing it correctly. Your symptoms should begin to improve after 3 sessions.

References

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 127.

Deutsch JK, Hass DJ. Complementary, alternative, and integrative medicine. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 131.

Iturrino JC, Lembo AJ. Constipation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 19.

Pardi DS, Cotter TG. Other diseases of the colon. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 128.

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