Bowel retraining

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 Dulcolax) 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.