Bowel training helps to reestablish normal bowel movements in persons who suffer from constipation, diarrhea, incontinence, or irregularity. Healthy bowel activity is considered one or two movements of moderate size every day.
Many people for many reasons have irregular bowel function. In some cases, the irregularity lasts beyond the condition that caused it. The bowels by themselves develop bad habits that can be retrained with suitable exercises and education. Normal bowel habits not only improve the quality of life, they help prevent several common diseases—for example, diverticulitis and fecal impaction. Gall stones, appendicitis, colon cancer, hiatal hernia, diabetes, and heart disease have also been related to the quality of bowel movements and the foods that affect them.
- One of the most common causes of constipation is the laxative habit. Repeated artificial stimulation of the bowels destroys their natural emptying reflex, so that they will no longer move without artificial stimulants. The laxative habit begins innocently enough with the correct belief that bowels should move every day, however, laxatives will cause the evacuation of several days worth of stool in a single movement. Impatient for stool to reaccumulate for the necessary few days, the patient takes another laxative, and the cycle begins.
- The other major cause of constipation is a diet with insufficient bulk or roughage. The bowel works more smoothly the more contents it has. Western diets of highly refined foods have eliminated most of the residue from food. The result is that most food is absorbed, leaving little to pass through and be excreted as feces.
- Constipation occurs acutely with impaction—the presence in the rectum of a mass of feces too large to pass. Fecal impaction is usually the result of poor bowel habits, a diet with too little liquid and roughage, and inadequate physical activity.
- Diarrhea, whether acute or chronic, can disrupt the bowel's normal rhythm and lead to irregularity.
- Several diseases of the nervous system affect bowel reflexes.
Defecate— To pass feces (stool) out of the rectum through the anus.
Diverticulitis— Infection of outpouchings in the large bowel.
Fecal impaction— Obstruction of the rectum by a large mass of feces (stool).
Hiatal hernia— Part of the stomach displaced through the diaphragm into the chest.
Bowel training reestablishes the bowel's normal reflexes by repeating a routine until it becomes a habit. Naturally the patient must be able and willing to cooperate. Some patients are so convinced they need daily laxatives that they are afraid to do without them. It takes time for a changed diet to effect the bowels and for the bowel to regain its normal rhythm. Trust and patience are necessary.
After gaining the patient's cooperation, the next step is to optimize the diet. Healthy bowel movements require ingestion of a large amount of liquids and bulk foods. The patient should drink two to three quarts of liquids every day, with liberal inclusion of prune juice and perhaps coffee for their natural laxative effect. Bulk comes from unrefined foods. Oat bran, wheat bran, brown rice, green vegetables, apples, and pears are a few examples of high residue foods. Many patients will benefit from adding bulk preparations of psyllium. Constipating foods like bananas and cheese should be avoided until a natural rhythm is well established.
To assure that stools are soft enough to pass easily, it is a good idea to add a pure stool softener like DOSS (dioctyl sodium sulfosuccinate), two to four per day as needed. DOSS also helps prevent impaction.
There is usually a time of day when bowel movements are more likely to occur. In anticipation of this time, the patient should participate in activities that stimulate a normal bowel movement. Walking, eating unrefined foods, and drinking prune juice or coffee, encourage natural evacuation. It is acceptable to use lubricants such as glycerine suppositories or oil enemas at this time. For severe constipation, water enemas may be needed to initiate a movement.
It is also important for the patient to recognize the urge to defecate and to respond right away to that urge. The longer stool sits in the rectum, the more water the rectum will absorb from it, making it harder and more difficult to pass.
With patience and diligence, normal bowel habits and the health that comes with them will return in most patients.
Barker, L. Randol, et al., eds. Principles of Ambulatory Medicine. Baltimore: William & Wilkins, 1994.