1. The client/caregiver can list the goals of bowel retraining.
   1. Regularity of bowel function
   2. Prevention of fecal incontinence and impaction
   3. Prevention of skin breakdown
   4. Improvement of client’s self-esteem
2. The client/caregiver can list preparatory measures to promote bowel retraining.
   1. Assess and record the client’s usual pattern of elimination.
      1. Record times of elimination.
      2. Record the usual stimulus for elimination.
   2. Establish a specific time for elimination, usually after a meal consistent with the client’s history.
   3. Eat a diet high in fiber to prevent constipation, but avoid foods that may cause diarrhea.
   4. Drink 3000 to 4000 ml of fluid per day unless contraindicated.
   5. Exercise regularly.
   6. Attain as normal a position as possible for defecation, such as sitting on a bedside commode or toilet and leaning forward.
3. The client/caregiver can describe the procedure for bowel retraining.
   1. Drink 4 ounces of prune juice each evening.
   2. Drink warm fluids just before evacuation to promote peristalsis.
   3. Insert rectal glycerin suppository (Dulcolax if glycerin is not effective) 30 minutes before the scheduled time for defecation.
   4. Have the client sit on the toilet with feet placed on a stool, if possible, for defecation.
   5. Instruct the client to bear down and contract abdominal muscles.
   6. Massaging the abdomen from right to left may be helpful.
   7. Rectal stimulation may also be required to promote defecation.
   8. Allow adequate time for defecation.
   9. Record daily the stool amount, consistency, and so forth.

References

Canobbio, M. M. (2006). Mosby’s handbook of patient teaching . St. Louis: Mosby Inc.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Timby, B. K. (2005). Fundamental nursing skills and concepts. Philadelphia: J. B. Lippincott Williams &
Wilkins.