Bowel Retraining for Fecal Incontinence
Bowel retraining is a gentle, low-risk way to get more control over your bowels. It doesn’t involve surgery or a procedure. You train your bowels to empty on a regular, predictable schedule, so you’re on the toilet when stool is ready to come out instead of caught off guard. Many people who stick with it see real improvement. It takes patience, though. Most need several weeks to a few months before they notice a big difference.
What is bowel retraining?
It’s three things done together: changes to what you eat and drink, trips to the toilet at set times, and exercises for the muscles that hold stool in. The diet and the schedule make your bowel movements more regular. The exercises make those muscles stronger.
How it works
Your bowels naturally get more active after you eat. Doctors call this the gastrocolic reflex. It’s strongest about 15 to 45 minutes after a meal, so that’s usually the best time to sit on the toilet. If you go at the same time every day, your body starts to expect it.
How you sit matters too. A good position makes stool come out more easily, without pushing hard. Fiber and fluids help you get stool that’s well formed and regular, not too loose and not too hard. Pelvic floor exercises build up the muscles that keep stool in until you’re ready.
Some people also do biofeedback. A sensor and a screen show you what your pelvic floor muscles are doing while you squeeze and relax, so you can learn to control them better.
The steps
Start by keeping a bowel diary for at least a week. Write down when you have bowel movements, what you eat and drink, and any time you leak. That diary tells you when your bowels tend to be active.
Then build your routine:
- Pick one to three times each day to try for a bowel movement, based on what your diary shows. After a meal is usually a good choice.
- At those times, sit on the toilet for 10 to 15 minutes, even if nothing happens.
- Lean forward a little and keep your knees higher than your hips. Don’t strain.
- Any time you feel the urge to go, head to the toilet right away. Don’t hold it.
- Work with your doctor to get the right amount of fiber and fluid.
- Do Kegel exercises to strengthen your pelvic floor.
Keep the same schedule on weekends and holidays. Bowel retraining works best when you’re consistent.
Tips that help
Give it time. You may not see much change for several weeks. Drink plenty of water and get regular exercise. If certain foods give you loose stools or make you constipated, cut back on them. A small step stool under your feet on the toilet makes it easier to get your knees above your hips.
When it isn’t enough
Bowel retraining helps many people, but not everyone. If you’ve stuck with it for several weeks and you’re not better, or your symptoms are getting worse, talk with your doctor about other treatments.
Before you start
Check with a doctor before you begin a bowel retraining program, especially if you have other health problems.
Take the next step
If you have fecal incontinence and want help setting up bowel retraining, or want to talk about other options, schedule a visit with me. Bring your bowel diary if you’ve started one. It gives us a head start on figuring out your schedule.
References
- Brown HW, Dyer KY, Rogers RG. Management of Fecal Incontinence. Obstetrics & Gynecology. 2020. doi:10.1097/AOG.0000000000004054
- Meyer I, Richter HE. Accidental Bowel Leakage/Fecal Incontinence: Evidence-Based Management. Obstetrics and Gynecology Clinics of North America. 2021. doi:10.1016/j.ogc.2021.05.003
- Sultan AH, Monga A, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. International Urogynecology Journal. 2017. doi:10.1007/s00192-016-3140-3
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology. 2019. doi:10.1097/GCO.0000000000000584
- Jelovsek JE, Markland AD, Whitehead WE, et al. Controlling anal incontinence in women by performing anal exercises with biofeedback or loperamide: a randomised clinical trial. Lancet Gastroenterology & Hepatology. 2019. doi:10.1016/S2468-1253(19)30193-1