Bowel retraining

Alternative names 
Exercises for fecal incontinence


People with fecal incontinence resulting from a variety of causes may benefit from a program of bowel retraining, Kegel exercises, or biofeedback therapy. The bowel program consists of several steps aimed at producing regular bowel movements. Within a few weeks of beginning a bowel program, most people can achieve regular bowel movements.

Prior to beginning a bowel training program, you should receive a thorough physical examination to identify the cause of the fecal incontinence and treat any correctable disorders, such as a fecal impaction or infectious diarrhea. A history of your bowel habits and lifestyle considerations should serve as a guide for establishing new bowel elimination patterns.

The diet should be modified to include adequate fiber and fluid intake to promote regular, soft, bulky stools. Add high fiber foods to the diet including whole-wheat grains, fresh vegetables, and beans. Additionally, psyllium-containing products such as Metamucil can be used to add bulk to the stools. Try to drink 2 to 3 liters of fluid a day (unless you have a medical condition requiring you to restrict your fluid intake, such kidney or heart disease).

Establish a set time for daily bowel movements; choose a time that is convenient for you keeping in mind your daily schedule. It is very important to be consistent in the time of day bowel training is performed. The best time for a bowel movement is 20 to 40 minutes after a meal since feeding stimulates bowel activity. Some people drink warm prune juice or fruit nectar as a stimulus to bowel movements.

Bowel movements may be stimulated by digital stimulation. Digital stimulation is performed by inserting a lubricated finger into the anus and using a circular motion. Stimulate the lower bowel until the sphincter relaxes. This may take a few minutes. If digital stimulation does not produce a bowel movement within 20 minutes, repeat the procedure.

Digital stimulation should be performed every day to stimulate bowel movement, until a pattern of regular bowel movements is established. Bowel movements may also be stimulated by using a suppository (glycerin or Dulcolax) or a small enema.

After stimulation has been performed, assume a normal posture for 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, in as close to a sitting position as possible, or use a left side lying position if unable to sit. Try to ensure privacy as much as possible. Also, some people find that reading while sitting on the commode helps them relax and aids in bowel evacuation.

Try to contract the abdominal muscles and bear down while expelling the stool. Some people find it helpful to bend forward while bearing down, as this increases the abdominal pressure and helps evacuate the bowel.

Consistency is crucial for the success of a bowel retraining program. Try to establish a time for bowel movements and stick to this time. Within a few weeks, most people are able to establish a regular routine of bowel movements.

Strengthening the tone of the rectal muscles may help achieve some degree of bowel control in those people who have fecal incontinence caused by an incompetent rectal sphincter. Exercises to strengthen pelvic and rectal muscle tone are called Kegel exercises. These exercises were originally developed as a method of controlling incontinence in women following childbirth. The success of Kegel exercises depends on proper technique and adherence to a regular exercise program.

Biofeedback is a method of providing audio or visual feedback to a person about some bodily function, such as muscle activity. In people with fecal incontinence, biofeedback is used to strengthen the tone of 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. The person is taught how to squeeze the rectal muscle around the rectal plug, using the computer display as a guide to ensure correct technique. The person should see an improvement in symptoms after three sessions.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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