The goal of bowel retraining is to return you to a normal and convenient pattern of defecation. People who experience fecal incontinence, constipation, and difficulty with defecation or incomplete bowel emptying can show improvement with this retraining technique. Bowel retraining helps to keep you regular with normal stool consistency of Type 4 per Bristol Stool Chart so that defecation is easy (no straining, pushing, or forcing). The program includes education about bowel function and defecation. The success of the program depends on your discipline and compliance with the program.
THE RETRAINING PROGRAM
- Each morning upon arising, go to the toilet and completely empty your bladder. Then sit on the toilet for an additional 5 minutes with your feet on a stool. This is to give your body opportunity to have a bowel movement by taking advantage of the gastrocolic-reflex. Repeat this process (sit for 5 minutes with feet on stool) after eating breakfast, lunch and dinner. Try to get to the toilet within 5 minutes of finishing your meal. I refer to this as the 5/5 rule because within 5 minutes of waking and finishing your meals, you will sit on the toilet for 5 minutes.
- Do not push or strain or try to force a bowel movement (BM). Nothing may happen during those 5 minutes and that’s okay (not a failure!) or maybe you’ll pass gas or have a BM. Just focus on diaphragm breathing and relaxing your pelvic floor. Having your feet on a stool allows the puborectalis muscle to relax which straightens out the rectal angle allowing for easier normal defecation.
- It is never okay to suppress a bowel urge. Even if you already had a BM you still need to follow schedule and sit on the toilet on your scheduled times. Remember, we are retraining for proper frequency and regularity. So go to the toilet at the scheduled time even if you do not feel the need to defecate. It is important to relax and not strain while voiding or defecating.
- It is natural to urinate when you sit on the toilet, no need to suppress this but be cognizant of your next void as to prevent excessive urinary frequency leading to bladder dysfunctions. See What is Normal for proper bladder function.
EATING AND DRINKING
- What you eat and drink influences your bowel function.
- You must get between 25-35g of fiber a day. This should be spread out between meals (i.e. approximately 9-12g at each meal). Do not take a fiber supplement that gives you a high dose of fiber all at once (i.e. 20g of fiber in a fiber bar or cereal). Too much at one time can have adverse effects. And remember you need a balance of insoluble and soluble fiber.
- You must drink water for fiber to work! You must sip water throughout the day averaging 4-6oz every hour. Do not go several hours without water and then drink a lot of water (>12 oz) quickly to “make up for it”—that’s not how it works! Create a habit of sipping water consistently throughout the day.
- You need to take a probiotic that has a minimum of 20 billion cultures daily with food for digestive health. Ask your Physician or Dietician for specific probiotic recommendations.
DEALING WITH PROBLEMS AND SET BACKS
Setbacks are not uncommon if you have been ill with a cold or flu, are tired, cannot completely concentrate on the program, feel nervous or tense, are sensitive to cold weather or the sound of running water, traveling, or are about to start your menstrual period.
If you do not have a foot stool (at work or at a restaurant) raise your heels to bring your knees higher than your hips, however, try to keep the tension out of your pelvic floor if you do this. It is best to have a stool when possible so you can relax.
Example Schedule and Summary:
Wake up: Pee and “Poo” (meaning sit on toilet for 5 mins)
Breakfast: Pee and “Poo” (within 5 minutes of finishing meal, sit for 5 mins)
Pee (3 hours later)
Lunch: Pee and “Poo” (within 5 minutes of finishing meal, sit for 5 mins)
Pee (3 hours later)
Dinner: Pee and “Poo” (within 5 minutes of finishing meal, sit for 5 mins)
Pee before bed.
Depending on how much time is between breakfast, lunch, and dinner you may have to urinate again (if it is greater than 3 hours). For example if you eat breakfast at 7 and lunch at 1 then you will need to urinate at 10 because 6 hours between voids is too long. On the other hand, if you get up at 5 and eat at 6, you would not void again between waking and eating breakfast. Try not to urinate sooner than 2 hours unless that conflicts with when you have to sit to “Poo”.