bowel training 1

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.