bowel training [OFr, boel] , a method of establishing regular evacuation by reflex conditioning used in the treatment of fecal incontinence, impaction, chronic diarrhea, and autonomic hyperreflexia. In patients with autonomic hyperreflexia, distension of the rectum and bladder causes paroxysmal hypertension, restlessness, chills, diaphoresis, headache, elevated temperature, and bradycardia. ▪ METHOD: The patient’s previous bowel habits are assessed, and the necessity of developing a program to induce an evacuation at the same time each day or every other day is explained. Exercises to strengthen abdominal muscles, such as pushing up, bearing down, and contracting the musculature, are demonstrated. The patient is instructed to recognize and respond promptly to signals indicating a full bowel and to develop cues to stimulate the urge to defecate, such as drinking coffee or massaging the abdomen. Fluids to 3000 mL daily are encouraged, exercise is increased as able, and the importance of eating well-balanced meals that include bulk and roughage is discussed. Depending on the patient and the problem, the training program may involve drinking warm fluid, ensuring privacy, and inserting a lubricated glycerin suppository before the set time. The possibility that emotional stress or illness may cause accidental incontinence after the program has been established is discussed. Many clients require weeks or months of training to achieve success. ▪ INTERVENTIONS: It is important that patients fully participate in the planning of the program as the activities become a part of the patient’s daily routine. As the program is implemented, revisions may be necessary. Regular exercise and physical activity, when possible, are interventions that contribute to the success of the program. ▪ OUTCOME CRITERIA: Reflex conditioning is often an effective method of developing regular bowel habits for incontinent patients, especially those who are highly motivated and are given good instruction and understanding support.
