Bowel Retraining

Bowel retraining
<span>To use the sharing features on this page, please enable JavaScript.</span> Email this page to a friend Share on facebook Share on twitter Bookmark & Share Printerfriendly version A program of bowel retraining, Kegel exercises, or biofeedback therapy may be used by people with:

Fecal incontinence Nerve problems (such as from multiple sclerosis or other conditions) Severe constipation
The bowel program has several steps that help with regular bowel movements. Within a few weeks of beginning a bowel program, most people can have regular bowel movements. Before starting a bowel training program, get a thorough physical examination. Your health care provider can find the cause of the fecal incontinence and treat any correctable disorders, such as a fecal impaction or infectious diarrhea. The doctor will use your history of bowel habits and lifestyle as a guide for setting new bowel movement patterns. DIET The following dietary changes can help promote regular, soft, bulky stools:

Add high-fiber foods to your diet, including whole-wheat grains, fresh vegetables, and beans. Use products containing psyllium, such as Metamucil, to add bulk to the stools. Try to drink 2 - 3 liters of fluid a day (unless you have a medical condition, such as kidney or heart disease, 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 and make a circular motion until the sphincter relaxes. This may take a few minutes. After you have done the stimulation, sit in a normal posture 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, or use a left side lying position if you are unable to sit. Try to get as much privacy as possible. Some people find that reading while sitting on the toilet helps them relax enough to have a bowel movement. If digital stimulation does not produce a bowel movement within 20 minutes, repeat the procedure. Try to contract the muscles of the abdomen and bear down while releasing the stool. Some people find it helpful to bend forward while bearing down. This increases the abdominal pressure and helps empty the bowel.
Perform digital stimulation every day until you establish a pattern of regular bowel movements. You can also stimulate bowel movements by using a suppository (glycerin or bisacodyl) or a small enema. Some people drink warm prune juice or fruit nectar to stimulate bowel movements.
Consistency is crucial for the success of a bowel retraining program. Establish a set time for daily bowel movements. Choose a time that is convenient for you, keeping in mind your daily schedule. The best time for a bowel movement is 20 - 40 minutes after a meal, because feeding stimulates bowel activity. Within a few weeks, most people are able to establish a regular routine of bowel movements. KEGEL EXERCISES Strengthening the tone of the rectal muscles may help achieve some degree of bowel control in people who have an incompetent rectal sphincter. Kegel exercises strengthen pelvic and rectal muscle tone. 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. BIOFEEDBACK Biofeedback gives you sound or visual feedback about a bodily function, such as muscle activity. In people with fecal incontinence, biofeedback is used to strengthen the rectal sphincter. A rectal plug is used to monitor the strength of the rectal muscles. A monitoring electrode may be placed on the abdomen. The rectal plug is then attached to a computer monitor, which displays a graph showing rectal muscle contractions and abdominal contractions. You are taught how to squeeze the rectal muscle around the rectal plug. The computer display guides you to make sure you are using the correct technique. You should see an improvement in your symptoms after three sessions.
Different Types of Bowel Management and Care

Bowel Care and Management Sections

Function of the Bowel The Reflex and Flaccid Bowel Methods of Bowel Management and Care Possible Complications Following a Spinal Cord Injury
Methods of Bowel Management and Care

The primary purpose of establishing an effective bowel management program, or bowel routine, is to allow the individual to minimise the risk of bowel accidents, and organise an acceptable time for the bowel to be emptied in a safe manner. All people with a spinal cord injury have the potential for involuntary bowel movements, due to the lack of sensation, and the inability to sense when the rectum is full. On average, around 11% of individuals with a chronic spinal cord injury, suffer one or more accidental bowel movements per week. Many people with spinal cord injuries, regard accidental bowel movements as one of the most distressing aspects of their post injury lives. Bowel accidents can have an impact on self confidence, impact social life and reduce recreational activities, as well as having a negative impact of educational and employment opportunities. Minimising accidental bowel movements, is therefor a high priority in improving the quality of life for those affected by spinal cord injuries.
Management of the Reflex Bowel or Upper Motor Neuron Bowel

In a person with a reflex bowel dysfunction, the bowel reflex can be utilised to evacuate the bowel of faeces by using chemical rectal stimulation, digital rectal stimulation, or a combination of both. A similar process of bowel evacuation in a reflex or upper motor neuron bowel, is recommended in most spinal cord injury centres as follows (From: Ash 2005):
1 Digital Rectal Examination

Digital removal of some faeces may be necessary if the rectum is already full, so that sufficient space is created to enable the rectal stimulant to achieve maximum contact with the rectal wall for best effect.
2 Insert Prescribed Rectal Stimulant

Suppositories or micro enemas which need to be left in situ for an appropriate period of time to deliver effective stimulation.
3 Digital 'Rectal Checking'

To assess the completeness of reflex evacuation
4 Digital Rectal Stimulation

To trigger further evacuation. The established bowel routine programme should stipulate a minimum and maximum period of digital rectal stimulation.
5 Repeat Stages 3 and 4

Until rectum is empty.
6 Finish Management of the Flaccid Bowel or Lower Motor Neuron Bowel

In a person with a flaccid bowel, the stool tends to be hard. This can help in the bowel management, as it reduces the risk of accidental bowel movements due to the requirement of digital removal. As the external anal sphincter is open in a lower motor neuron bowel, a hard stool is less likely to be forced out of the rectum, than an upper motor neuron stool consistency. Because there is no reflex in the bowel, chemical stimulants do not work, and so the principle method of bowel evacuation, is the use of digital rectal stimulation. In digital rectal stimulation, a gloved finger is inserted into the rectum via the anal canal. If faeces are detected, they are carefully removed by using a circling action of the finger.
Bowel Routine
A bowel routine can be very time consuming, and over 40% of people with a chronic spinal cord injury, spend over an hour on their routine. An acceptable time of no longer than an hour is the accepted target for a bowel routine. The period between bowel movements can vary, but the generally accepted times are every other day for a reflex bowel, and once a day for a flaccid bowel. If the time periods are increased between bowel movements, then bowel accidents can occur, as well as constipation, impaction and in those with a spinal cord injury above T6, autonomic dysreflexia. One of the most important factors in preventing bowel accidents is to keep to a routine. This routine also includes diet, and part of a healthy bowel routine is a healthy diet.

Bowel Retraining

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Bowel retraining

Different Types of Bowel Management and Care

Methods of Bowel Management and Care

Management of the Reflex Bowel or Upper Motor Neuron Bowel

1 Digital Rectal Examination

2 Insert Prescribed Rectal Stimulant

3 Digital 'Rectal Checking'

4 Digital Rectal Stimulation

5 Repeat Stages 3 and 4

6 Finish Management of the Flaccid Bowel or Lower Motor Neuron Bowel

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