Habit Training

A voiding diary is the starting point for bladder training by allowing the patient to see how often voiding and incontinence actually occur. This is then used to set a voiding interval. Patients who are infrequent voiders are instructed to do timed voiding every 2 to 2-1/2 hours during waking hours. Regular bladder emptying should result in less incontinent episodes. Patients are then instructed to increase the voiding interval by 15 to 30 minutes per week in order to achieve voiding every 3 to 4 hours while awake with less urgency and less incontinence. Timed voiding has been proven effective in patients with urgency, frequency, and urge and stress incontinence. The goal of retraining is increased functional bladder capacity. The initial prescribed voiding interval may be as little as every 30 minutes in patients whose baseline diaries show voiding occurs more often than every 30 minutes. Urge suppression strategies assist with maintaining bowel and bladder control by educating patients to respond adaptively to the sensation of urgency. Rather than rushing to the toilet, which increases intraabdominal pressure and exposes patients to visual cues that can trigger incontinence, patients are encouraged to pause, sit down if possible, relax the entire body, and contract PFMs repeatedly to diminish urgency, inhibit detrusor contractions, and prevent urine loss. When urgency subsides, patients are instructed to proceed to the toilet at a normal pace. Patients with mixed urinary incontinence are also taught stress loss prevention strategies, which consist of contracting the PFMs just before and during any physical activities such as coughing or sneezing that may trigger stress incontinence. These strategies, although intended for urinary incontinence, are quite helpful in maintaining control for patients with fecal incontinence. Norton and Kamm2 reported that an enhanced ability to contract the anal sphincter is likely to diminish large bowel peristalsis, may even induce retrograde peristalsis, or may simply allow continence to be preserved until the urge (bowl contractions) ceases. This seems to relate to the ability of biofeedback treatment to modify urgency.2

Bowel habit training is recommended for patients with symptoms of incomplete, difficult, or infrequent evacuation. Patients are encouraged to set aside 10 to 15 minutes at approximately the same time each day for unhurried attempts to evacuate. The patient should not be overly concerned with any failure because another attempt later in the day is acceptable. This is best initiated after a meal, which stimulates the gastrocolic reflex.

Most commodes are approximately 35 to 40 cm in height; if a patient's feet or legs hang free or dangle above the floor while sitting, simulation of the squatting position will not be accomplished. Full flexion of the hips stretches the anal canal in an anteroposterior direction and tends to open the anorectal angle, which facilitates rectal emptying. This may be achieved by the use of a footstool to elevate the legs and flex the hips.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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