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Bowel retraining

Alternative Names

Fecal incontinence exercises

Information

A program of bowel retraining, Kegel exercises , or biofeedback therapy may be used by people to help improve their bowel movements. Conditions that it may help include:

The bowel program includes several steps to help you have regular bowel movements. Most people are able to have regular bowel movements within a few weeks. Some people will need to use laxatives along with bowel retraining. Your provider can tell you if you need to take these medicines and which ones are safe for you.

You will need a physical exam before you start a bowel training program. This will allow your provider to find the cause of the fecal incontinence. Disorders that can be corrected such as fecal impaction or infectious diarrhea can be treated at that time. The provider will use your history of bowel habits and lifestyle as a guide for setting new bowel movement patterns.

DIET

Making the following changes to your diet will help you have regular, soft, bulky stools:

Eat high-fiber foods such as whole-wheat grains, fresh vegetables, and beans.

Use products containing psyllium, such as Metamucil, to add bulk to the stools.

Try to drink 2 to 3 liters of fluid a day (unless you have a medical condition 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. Move it in a circle until the sphincter muscle relaxes. This may take a few minutes.
  • After you have done the stimulation, sit in a normal position 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. If you are unable to sit, lie on your left side.
  • Try to get as much privacy as you can. Some people find that reading while sitting on the toilet helps them relax.
  • If you do not have a bowel movement within 20 minutes, repeat the process.
  • Try to contract the muscles of the abdomen and bear down while releasing the stool. You may 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 start to have a regular pattern of bowel movements.
  • You can also stimulate bowel movements by using a suppository (glycerin or bisacodyl) or a small enema. Some people find it helpful to drink warm prune juice or fruit nectar.

Keeping to a regular pattern is very important for a bowel retraining program to succeed. Set a regular time for daily bowel movements. Choose a time that is convenient for you. Keep in mind your daily schedule. The best time for a bowel movement is 20 to 40 minutes after a meal, because feeding stimulates bowel activity.

Most people are able to establish a regular routine of bowel movements within a few weeks.

KEGEL EXERCISES

Exercises to strengthen the rectal muscles may help with bowel control in people who have an incompetent rectal sphincter. Kegel exercises that strengthen pelvic and rectal muscle tone can be used for this. 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. Talk with your health care provider for instructions about how to do Kegel exercises.

BIOFEEDBACK

Biofeedback gives you sound or visual feedback about a bodily function. In people with fecal incontinence, biofeedback is used to strengthen the rectal sphincter.

A rectal plug is used to detect the strength of the rectal muscles. A monitoring electrode is placed on the abdomen. The rectal plug is then attached to a computer monitor. A graph displaying rectal muscle contractions and abdominal contractions will show up on the screen.

To use this method, you will be taught how to squeeze the rectal muscle around the rectal plug. The computer display guides you to make sure you are doing it correctly. Your symptoms should begin to improve after three sessions.

References

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 138.

Cook IJ, Brookes SJ, Dinning PG. Colonic motor and sensory function and dysfunction. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger& Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 98.

Updated: 8/19/2014

Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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