bowel training


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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.
  • One of the most common causes of constipation is the laxative habit. Repeated artificial stimulation of the bowels destroys their natural emptying reflex, so that they will no longer move without artificial stimulants. The laxative habit begins innocently enough with the correct belief that bowels should move every day, however, laxatives will cause the evacuation of several days worth of stool in a single movement. Impatient for stool to reaccumulate for the necessary few days, the patient takes another laxative, and the cycle begins.
  • The other major cause of constipation is a diet with insufficient bulk or roughage. The bowel works more smoothly the more contents it has. Western diets of highly refined foods have eliminated most of the residue from food. The result is that most food is absorbed, leaving little to pass through and be excreted as feces.
  • Constipation occurs acutely with impaction—the presence in the rectum of a mass of feces too large to pass. Fecal impaction is usually the result of poor bowel habits, a diet with too little liquid and roughage, and inadequate physical activity.
  • Diarrhea, whether acute or chronic, can disrupt the bowel's normal rhythm and lead to irregularity.
  • Several diseases of the nervous system affect bowel reflexes.

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.

bowel

 [bow´el]
bowel bypass syndrome a syndrome that may occur one to six years after jejunoileal bypass, characterized by rash, malaise, myalgia, polyarthralgia, sterile skin pustules, and a flulike illness; it is probably caused by circulating immune complexes that include bacterial antigens resulting from bacterial overgrowth in the bypassed bowel.
bowel sounds relatively high-pitched abdominal sounds caused by the propulsion of the intestinal contents through the lower alimentary tract. Auscultation of bowel sounds is best accomplished by using a diaphragm-type stethoscope rather than a bell-shaped one. Normal bowel sounds are characterized by bubbling and gurgling noises that vary in frequency, intensity, and pitch. In the presence of distention from flatus, the sounds are hyperresonant and can be heard over the entire abdomen.

The absence of bowel sounds is symptomatic of greatly decreased or totally absent peristaltic movement. This can occur in such conditions as paralytic ileus, advanced intestinal obstruction, gangrene of the bowel, enterocolic ulceration, myxedema, and spinal cord injury. In the early stages of bowel obstruction, high-pitched splashing sounds are heard in the intestine proximal to the obstruction. As the obstruction continues to constrict the lumen of the bowel, the sounds are of shorter duration and eventually cease altogether as the obstruction to the lumen of the bowel becomes complete.

Increased motility of the bowel usually results from some sort of irritating stimulus, such as gastroenteritis with diarrhea, bleeding in the intestine, and emotional disorders. Hyperactivity of the bowel produces a rush of sounds, with waves of loud, gurgling, and tinkling sounds called borborygmi.
bowel training
1. a nursing intervention classification defined as assisting the patient to learn to evacuate the bowel at specific intervals.
2. a program designed to help the patient having difficulty with the regulation and control of defecation. A program of this type may be indicated in cases ranging from chronic constipation to paralysis, as in paraplegia and hemiplegia. Patients who suffer from lesions or congenital anomalies of the intestinal tract also may benefit from such a program.

Before planning a program of bowel control it is necessary to determine the cause of the difficulty, the patient's former bowel habits, and specific symptoms. The plan devised will depend on the patient's needs and physical, mental, and emotional capacities for cooperation in the planning and implementation of the program. It is necessary to know whether the person can realistically be expected to achieve complete control, or if neural damage or anatomical and structural changes in the intestine prevent reaching this goal. For example, a colostomy patient cannot achieve complete control over bowel movements, but regulation of diet and fluid intake can affect the number and consistency of the stools, giving some sense of security. Diet also is important in all other types of bowel training in which the goal is regularity of defecation and stools of normal consistency.

It is important that patients participate as much as possible in planning the program. They will need to give an accurate history of bowel habits, former use of laxatives and enemas, usual time of day for bowel movements, and the frequency, and whether or not they are aware of the urge to defecate. As the program is carried out, revisions may be necessary as the patient learns which techniques are most helpful.

The major components of a bowel training program are choosing the location to ensure some degree of privacy, getting the patient into a sitting position, having him attempt defecation at a specific time that is most natural for him, regulating the food and fluid intake, and establishing some plan of regular exercise and physical activity.

In some cases of paralysis it may be necessary to stimulate bowel function through the use of suppositories and digital stimulation. Enemas, laxatives, and bulk-forming medications are used only if necessary, not on a regular basis if at all possible. These measures may be necessary, however, at the beginning of a bowel training program to remove constipated stool and fecal impaction.

training

 [trān´ing]
1. a system of instruction or teaching.
2. preparation by instruction and practice; see also education.
assertiveness training instruction in techniques for handling of interpersonal conflicts and threatening situations without either submissiveness or aggression; see also assertiveness training.
in the nursing interventions classification, a nursing intervention defined as assistance with the effective expression of feelings, needs, and ideas while respecting the rights of others.
autogenic training in the nursing interventions classification, a nursing intervention defined as assisting with self-suggestions about feelings of heaviness and warmth for the purpose of inducing relaxation.
bladder training a program designed to help a patient gain better control over the flow of urine; examples include prompted voiding, bladder drill, patterned urge response toileting, pelvic floor exercises, and double void. Called also urinary bladder training.
bowel training a program to help a patient to learn to evacuate the bowel at specific intervals; see also bowel training.
gait training systematic activities designed to promote walking with or without assistive devices.
impulse control training in the nursing interventions classification, a nursing intervention defined as assisting the patient to mediate impulsive behavior through application of problem-solving strategies to social and interpersonal situations.
memory training in the nursing interventions classification, a nursing intervention defined as facilitation of memory.
urinary bladder training
2. in the nursing interventions classification, a nursing intervention defined as improving bladder function for those with urge incontinence by increasing the bladder's ability to hold urine and the patient's ability to suppress urination.
urinary habit training in the nursing interventions classification, a nursing intervention defined as establishing a predictable pattern of bladder emptying to prevent incontinence for persons with limited cognitive ability who have urge, stress, or functional incontinence.

bowel training1

Etymology: OFr, boel
a method of establishing regular evacuation by reflex conditioning used in the treatment of fecal incontinence, impaction, chronic diarrhea, and autonomic hyperreflexia. In patients with autonomic hyperreflexia, distension of the rectum and bladder causes paroxysmal hypertension, restlessness, chills, diaphoresis, headache, elevated temperature, and bradycardia.
method The patient's previous bowel habits are assessed, and the necessity of developing a program to induce an evacuation at the same time each day or every other day is explained. Exercises to strengthen abdominal muscles, such as pushing up, bearing down, and contracting the musculature, are demonstrated. The patient is instructed to recognize and respond promptly to signals indicating a full bowel, such as goose pimples, perspiration, and piloerection on arms or legs, and to develop cues to stimulate the urge to defecate, such as drinking coffee or massaging the abdomen. Fluids to 3000 mL daily are encouraged; exercise is increased as able, and the importance of eating well-balanced meals that include bulk and roughage and of avoiding constipating or gas-producing foods, such as bananas, beans, and cabbage, is discussed. Depending on the patient and the problem, the training program may involve drinking warm fluid, ensuring privacy, and inserting a lubricated glycerin suppository before the set time. The patient is told that no formed stools for 3 days, semiliquid feces, restlessness, and discomfort are signs of impending impaction and that the condition may be treated with a laxative suppository or with a tap water or oil retention enema. The importance of reporting symptoms of autonomic hyperreflexia to the physician is stressed. The possibility that emotional stress or illness may cause accidental incontinence after the program has been established is discussed. Many clients require weeks or months of training to achieve success.
interventions The nurse provides instruction, encourages the patient to establish a program of regular evacuation, and offers positive reinforcement frequently.
outcome criteria Reflex conditioning is often an effective method of developing regular bowel habits for incontinent patients, especially those who are highly motivated and are given good instruction and understanding support. Young persons with spinal cord lesions are able to develop automatic defecation when adequately trained, but some elderly incontinent people may not be able to learn the program.

bowel training2

a nursing intervention from the Nursing Interventions Classification (NIC) defined as assisting the patient to train the bowel to evacuate at specific intervals. See also Nursing Interventions Classification.

bow·el train·ing

(bow'ĕl trān'ing)
A method of establishing or reestablishing regularity of fecal elimination. May be accomplished by dietary, pharmacologic, and/or mechanical (enemas, digital stimulation) interventions.

bowel


bowel edema
see edema disease.
bowel entrapment
see intestinal strangulation.
hemorrhagic bowel syndrome
see proliferative hemorrhagic enteropathy.
bowel sounds
relatively high-pitched abdominal sounds caused by the propulsion of the intestinal contents through the lower alimentary tract. Auscultation of bowel sounds is best accomplished by using a diaphragm-type stethoscope rather than a bell-shaped one. Normal bowel sounds are characterized by bubbling and gurgling noises that vary in frequency, intensity and pitch. In the presence of distention from flatus, the sounds are hyperresonant and can be heard over the entire abdomen.
bowel training