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Bowel retraining

Show Alternative Names
Fecal incontinence exercises
Neurogenic bowel - bowel retraining
Constipation - bowel retraining
Obstipation - bowel retraining
Bowel incontinence - bowel retraining

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

Information

Problems that may benefit from bowel retraining include:

  • Fecal incontinence, which is the loss of bowel control, causing you to pass stool unexpectedly and involuntarily. This can range from sometimes leaking a small amount of stool and passing gas, to not being able to control bowel movements.
  • Severe constipation.

These problems may be caused by:

  • Brain and nerve problems (such as from multiple sclerosis)
  • Emotional problems
  • Spinal cord damage
  • Previous surgery
  • Childbirth
  • Overuse of laxatives

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 fiber supplements and laxatives along with bowel retraining. Your health care provider can tell you if you need to take laxatives 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 or constipation. 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 pressure within the abdomen and helps empty the bowel. Many people find it helpful to put a foot stool in front of the toilet to rest their feet.
  • Perform stimulation with your finger every day until you start to have a regular pattern of bowel movements. If this is recommended, your provider or physical therapist will explain it to you. It is important to avoid trauma to the anus if you are performing stimulation.
  • 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 eating 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 pelvic and rectal muscles may help with bowel control in people who have incompetent anal sphincters. Kegel exercises that increase 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 provider for instructions about how to do these exercises.

BIOFEEDBACK

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

A rectal probe is used to detect the strength of the rectal muscles. A monitoring electrode is placed on the abdomen. The rectal probe 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 3 sessions.

Review Date: 8/12/2024

Reviewed By

Jenifer K. Lehrer, MD, Gastroenterologist, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

References

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 122.

Deutsch JK, Hass DJ. Complementary, alternative, and integrative medicine. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 131.

Iturrino JC, Lembo AJ. Constipation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 19.

Pardi DS, Cotter TG. Other diseases of the colon. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 128.

Disclaimer

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Multiple sclerosis

Multiple sclerosis

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Multiple sclerosis

Multiple sclerosis

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Multiple sclerosis - Animation

Multiple sclerosis can be a particularly debilitating disorder because your body essentially attacks itself. But you can learn to cope during attacks.

So, what causes multiple sclerosis?

Multiple sclerosis, or MS, is a disease in which your body's immune system eats away at the protective sheath that covers your nerves. The disorder disrupts communication between your brain and the rest of your body, meaning your nerve signals slow down or stop.

We don't know exactly why this happens. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may even play a role. We do know that the disorder affects more women than men, that you may get the disorder if you have a family history of MS, and that you are at higher risk if you live in a part of the world where MS is more common. It's typically diagnosed between the ages of 20 and 40, but we see the disorder at any age.

Now you may ask, how do you know you have multiple sclerosis?

Symptoms of MS can vary widely from person to person because the location and severity of each attack can be different. Episodes may last for days, weeks, or months. You may even have long periods where you have no symptoms. We call this remission.

Because MS may damage nerves in any part of the brain or spinal cord, you may have symptoms in many parts of the body. You may have muscle problems, including loss of balance, muscle spasms, numbness, trouble moving your arms or legs, even trouble walking. You may have bowel and bladder problems, such as constipation, trouble urinating, or a frequent urge to urinate. You may have double vision, eye pain, or uncontrolled eye movements. You will probably be tired a lot, and it's often worse in the late afternoon. And those are just a few of the many possible symptoms of MS.

Since symptoms of MS may mimic those of other nervous system disorders, your doctor will want to rule those out. Your doctor may suspect MS if you have trouble with two different parts of your central nervous system (such as abnormal reflexes) at two different times.

A neurological exam may show you have reduced function in one area of your body, or it may be spread over many parts of your body. You may have abnormal reflexes, decreased ability to move a part of your body, a loss of sensation. An eye exam might show abnormal pupil responses, changes in your visual field, or trouble seeing.

There is no known cure for MS, so your doctor will focus on therapies to slow down the disorder, to control your symptoms and help you maintain a normal quality of life. Your doctor can prescribe different medicines to help with this. You may have to take several medications.

Life expectancy with MS can be normal, or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years. The amount of disability and discomfort can depend on how often you have attacks, on how bad they are, and what part of the central nervous system is affected by each attack. Most people return to normal or near-normal function between attacks. But, over time, many people with MS will need a wheelchair.

To help you maintain a normal quality of life, your doctor may suggest physical therapy, speech therapy, occupational therapy, and support groups, depending on your needs. Starting an exercising program early in the course of your disorder, eating right, and getting enough rest can also help.

 

Multiple sclerosis - Animation

Multiple sclerosis can be a particularly debilitating disorder because your body essentially attacks itself. But you can learn to cope during attacks.

So, what causes multiple sclerosis?

Multiple sclerosis, or MS, is a disease in which your body's immune system eats away at the protective sheath that covers your nerves. The disorder disrupts communication between your brain and the rest of your body, meaning your nerve signals slow down or stop.

We don't know exactly why this happens. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may even play a role. We do know that the disorder affects more women than men, that you may get the disorder if you have a family history of MS, and that you are at higher risk if you live in a part of the world where MS is more common. It's typically diagnosed between the ages of 20 and 40, but we see the disorder at any age.

Now you may ask, how do you know you have multiple sclerosis?

Symptoms of MS can vary widely from person to person because the location and severity of each attack can be different. Episodes may last for days, weeks, or months. You may even have long periods where you have no symptoms. We call this remission.

Because MS may damage nerves in any part of the brain or spinal cord, you may have symptoms in many parts of the body. You may have muscle problems, including loss of balance, muscle spasms, numbness, trouble moving your arms or legs, even trouble walking. You may have bowel and bladder problems, such as constipation, trouble urinating, or a frequent urge to urinate. You may have double vision, eye pain, or uncontrolled eye movements. You will probably be tired a lot, and it's often worse in the late afternoon. And those are just a few of the many possible symptoms of MS.

Since symptoms of MS may mimic those of other nervous system disorders, your doctor will want to rule those out. Your doctor may suspect MS if you have trouble with two different parts of your central nervous system (such as abnormal reflexes) at two different times.

A neurological exam may show you have reduced function in one area of your body, or it may be spread over many parts of your body. You may have abnormal reflexes, decreased ability to move a part of your body, a loss of sensation. An eye exam might show abnormal pupil responses, changes in your visual field, or trouble seeing.

There is no known cure for MS, so your doctor will focus on therapies to slow down the disorder, to control your symptoms and help you maintain a normal quality of life. Your doctor can prescribe different medicines to help with this. You may have to take several medications.

Life expectancy with MS can be normal, or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years. The amount of disability and discomfort can depend on how often you have attacks, on how bad they are, and what part of the central nervous system is affected by each attack. Most people return to normal or near-normal function between attacks. But, over time, many people with MS will need a wheelchair.

To help you maintain a normal quality of life, your doctor may suggest physical therapy, speech therapy, occupational therapy, and support groups, depending on your needs. Starting an exercising program early in the course of your disorder, eating right, and getting enough rest can also help.

 
 
 
 

 

 
 
 
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