Bowel Training

Bowel Training 

Definition

Bowel training helps to reestablish normal bowel movements in persons who suffer from constipation, diarrhea, incontinence, or irregularity. Healthy bowel activity is considered one or two movements of moderate size every day.

Purpose

Many people for many reasons have irregular bowel function. In some cases, the irregularity lasts beyond the condition that caused it. The bowels by themselves develop bad habits that can be retrained with suitable exercises and education. Normal bowel habits not only improve the quality of life, they help prevent several common diseases—for example, diverticulitis and fecal impaction. Gall stones, appendicitis, colon cancer, hiatal hernia, diabetes, and heart disease have also been related to the quality of bowel movements and the foods that affect them.

Key terms

Defecate — To pass feces (stool) out of the rectum through the anus.

Diverticulitis — Infection of outpouchings in the large bowel.

Fecal impaction — Obstruction of the rectum by a large mass of feces (stool).

Hiatal hernia — Part of the stomach displaced through the diaphragm into the chest.

Description

Bowel training reestablishes the bowel's normal reflexes by repeating a routine until it becomes a habit. Naturally the patient must be able and willing to cooperate. Some patients are so convinced they need daily laxatives that they are afraid to do without them. It takes time for a changed diet to effect the bowels and for the bowel to regain its normal rhythm. Trust and patience are necessary.

After gaining the patient's cooperation, the next step is to optimize the diet. Healthy bowel movements require ingestion of a large amount of liquids and bulk foods. The patient should drink two to three quarts of liquids every day, with liberal inclusion of prune juice and perhaps coffee for their natural laxative effect. Bulk comes from unrefined foods. Oat bran, wheat bran, brown rice, green vegetables, apples, and pears are a few examples of high residue foods. Many patients will benefit from adding bulk preparations of psyllium. Constipating foods like bananas and cheese should be avoided until a natural rhythm is well established.

To assure that stools are soft enough to pass easily, it is a good idea to add a pure stool softener like DOSS (dioctyl sodium sulfosuccinate), two to four per day as needed. DOSS also helps prevent impaction.

There is usually a time of day when bowel movements are more likely to occur. In anticipation of this time, the patient should participate in activities that stimulate a normal bowel movement. Walking, eating unrefined foods, and drinking prune juice or coffee, encourage natural evacuation. It is acceptable to use lubricants such as glycerine suppositories or oil enemas at this time. For severe constipation, water enemas may be needed to initiate a movement.

It is also important for the patient to recognize the urge to defecate and to respond right away to that urge. The longer stool sits in the rectum, the more water the rectum will absorb from it, making it harder and more difficult to pass.

Normal results

With patience and diligence, normal bowel habits and the health that comes with them will return in most patients.

Resources

Books

Barker, L. Randol, et al., eds. Principles of Ambulatory Medicine. Baltimore: William & Wilkins, 1994.