# Bowel retraining...



## alpha66 (May 19, 2011)

I've been suffering with constipation for several months. Major symptom is that I feel no urge to defecate.So I've started bowel retraining for few weeks.I get up in the morning, drink a cup of metamucil, then sit on the toilet.From about 7 days ago I became to be able to move bowel. But I still feel no urge.I have to give it a bit of straining then it comes out. (I don't have to strain a lot or long... it takes only few seconds to push out poops)The stool is fairly hard even though I take 300mg of Docusate. (Lot of cracks on the stool surface) It seems like my colon motility is weak. Looks like it takes about 4 days for food I ate comes out through anus.Am I supposed feel no urge in this situation? Low motility, long transit time, hard stool... Are these the reason behind missing urge?Or am I not waiting enough to feel the urge?? Am I making BM by straining even before the urge kicks in????Can I still have slow transit time even if I have BM every day???If I have weak motility, is eating fiber (metamucil) bad???? I eat only 1 dose a day. Should I up it or stop it???


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## Kathleen M. (Nov 16, 1999)

The range for mouth to anus is 1-3 days (and usually for a slow transit study they look after 5 days), so 4 days isn't seriously slow. If what you are doing makes you able to go every day, then I would keep doing it.  Usually people who have to reduce fiber have a lot longer transit times than 4 days. Often at the end of 5 days the markers are still in the first part of the colon, not anywhere near the end.You've only had the daily movement for a week, I would give the bowel retraining more time. If you haven't had an urge for months or years it may take awhile of retraining to get the urge back. Even if you don't get the urge back ever, a routine that gets you to go every day is probably worth following.


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## alpha66 (May 19, 2011)

Kathleen M. said:


> The range for mouth to anus is 1-3 days (and usually for a slow transit study they look after 5 days), so 4 days isn't seriously slow. If what you are doing makes you able to go every day, then I would keep doing it. Usually people who have to reduce fiber have a lot longer transit times than 4 days. Often at the end of 5 days the markers are still in the first part of the colon, not anywhere near the end.You've only had the daily movement for a week, I would give the bowel retraining more time. If you haven't had an urge for months or years it may take awhile of retraining to get the urge back. Even if you don't get the urge back ever, a routine that gets you to go every day is probably worth following.


So, what do you recommend in my situation regarding fiber? Should I eat more???? I want more softer stool...Also, if my transit time is not that slow, why am I having hard stool??? Oh wait, in fact, it's not entirely hard but rather like "first half hard and last half soft"....But the hard first part is real hard (lots of cracks).And about the urge, you said, I could get the urge back with this retraining after a while. Do you know why my urge is gone at first place? (Can hard stool, slow transit be the reason?) How this retraining bring back the urge? Can you tell me more about this? Because this loss of urge is what I worried most because, without urge, I have to strain and I don't want to develop hemorrhoids.It's been about 4 months since I had regular urge (regular BM. once per day). And last time I had a proper urge was about a month ago when I waited for 3 days without having BM (without using any laxatives).I asked my PCP why I lost urge. He said I used laxatives too long and it caused nerves in the rectum to not work properly. But hey, I used only docusate, miralax and prune juice for about only 7 months. I don't think he knows what he is talking about...


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## Kathleen M. (Nov 16, 1999)

I don't know if they know why some people lose the urge, could be you aren't able to sense how full the rectum is, but could also be for some reason you learned to ignore it, so it takes awhile to relearn how to feel it.A quick push to get things going shouldn't be a problem. Usually the people who run into trouble are the ones that have too much urge even when they shouldn't and will strain for 15 minutes trying to get something out.Stool consistency isn't just "how long it takes" but how much fiber and how much water. Either play with fiber, or see if you need more prunes or other sorts of osmotic agents to keep the stool wet. It may just mean you need to drink a bit more water.


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## alpha66 (May 19, 2011)

Thanks Kathleen.Does motility has anything to do with urge? I mean, if you have weak peristalsis, can this lead to loss of urge???? Or the urge is solely depends on the bulk of fecal matter in the rectum???About the bowel retraining, Am I supposed to wait on the toilet until I feel the urge? or am I supposed to strain to move bowel initially then urge comes after a while as I keep doing training????


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## Kathleen M. (Nov 16, 1999)

Urge is really only a "rectum full" thing, not what is going on in the whole colon. Doesn't matter how fast stuff is moving you don't want the urge to go until the rectum needs to be emptied. Usually I've read sit at the same time every day and wait a bit for the urge before trying to make yourself go.


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## alpha66 (May 19, 2011)

Kathleen M. said:


> Urge is really only a "rectum full" thing, not what is going on in the whole colon. Doesn't matter how fast stuff is moving you don't want the urge to go until the rectum needs to be emptied. Usually I've read sit at the same time every day and wait a bit for the urge before trying to make yourself go.


So, I have probably fecal matter in the rectum already (that's why I need only little push for a successful BM) but can't feel the urge... Sounds like this is a some serious problem???? Or can this be a psychological problem???I don't hold off urge usually. I mean 99% of time, If I have urge then I just gr maybe the stool is already too hard when it comes down to rectum so it is not thick enough to stimulate rectum walls...Damn... I really want to know why I lost urge so that I can get it back...


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## Kathleen M. (Nov 16, 1999)

Try to relax about it and give your body a chance to try to send the signal. Getting worried or tense about it won't help things retrain.Plan on 10-15 minutes in the bathroom same time every day and sit for most of that just being present with what your body is doing. If the urge has been stimulated by a laxative before this it may be that the body is just a bit "lazy" if it doesn't have to do something it will stop doing that, just try to gently guide it back to what you want it to do.You've made good progress if you can go every day and it doesn't sound like your consistency is that far off normal, those are good things. Try to see each step as progress rather than worry why you aren't at your destination already.


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## alpha66 (May 19, 2011)

Kathleen M. said:


> Try to relax about it and give your body a chance to try to send the signal. Getting worried or tense about it won't help things retrain.Plan on 10-15 minutes in the bathroom same time every day and sit for most of that just being present with what your body is doing. If the urge has been stimulated by a laxative before this it may be that the body is just a bit "lazy" if it doesn't have to do something it will stop doing that, just try to gently guide it back to what you want it to do.You've made good progress if you can go every day and it doesn't sound like your consistency is that far off normal, those are good things. Try to see each step as progress rather than worry why you aren't at your destination already.


Thanks. I will try not to worry too much... (But you know and I know, we all know, it's not easy thing to do....







)


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## TummyDepressed (Feb 2, 2010)

Hi there - I have some symptoms like this..... Especially the first stool being hard and cracked. It seems this is where lots of little stool have formed into one larger one, (perhaps formed in rectum and joined together or in colon?).I have also lost the 'urge' to an extent. I think over the years my colon has enlarged so I cannot always tell when there is stool in it, when I need to go and when I don't!My transit time is different though... I generally pass what I have eaten the day before.....it just takes me a long time to get it out with each BM..


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## alpha66 (May 19, 2011)

TummyDepressed said:


> Hi there - I have some symptoms like this..... Especially the first stool being hard and cracked. It seems this is where lots of little stool have formed into one larger one, (perhaps formed in rectum and joined together or in colon?).I have also lost the 'urge' to an extent. I think over the years my colon has enlarged so I cannot always tell when there is stool in it, when I need to go and when I don't!My transit time is different though... I generally pass what I have eaten the day before.....it just takes me a long time to get it out with each BM..


I think the samething too. The first hard stool looks like many little stools formed into one large stool. I've been thinking that these cracks a due to lack of moisture in the stool. But this morning, I was able to separate this hard stool into several small pieces along the crack. So I wondere why this is happening.So how long have you been without urge? Without urge how do you move your bowel? Can you tell me moe about it?Do you know or can guess what causec loss of urge?In my case, oneday, I had very big hard stool. I felt like I was passing a beer tin can. After that day, I lost urge. Could this event be the cause of rectum distent and so loss of urge?


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## TummyDepressed (Feb 2, 2010)

I have been like this as long as I can remember. When I was young I had some problems with blocked bowel. I was in and out of hospital for about 3 months and reckon that episode may be related in some way. Perhaps I got a permanent injury/stretch or was pulled about by doctors.I don't move my bowel very successfully. It takes a long time. It is like it doesn't function properly. I just make sure I try to go at set times during the day... being backed up is the worst thing otherwise....


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## alpha66 (May 19, 2011)

TummyDepressed said:


> I have been like this as long as I can remember. When I was young I had some problems with blocked bowel. I was in and out of hospital for about 3 months and reckon that episode may be related in some way. Perhaps I got a permanent injury/stretch or was pulled about by doctors.I don't move my bowel very successfully. It takes a long time. It is like it doesn't function properly. I just make sure I try to go at set times during the day... being backed up is the worst thing otherwise....


Right. I never knew that constipation is this painful. When my symptom is at worst, I wonder if it is worth to live in such pain... I feel so miserable.Anyway, I finally felt urge yesterday and today!!!







I was so happy and relieved. I thought I had some structural problem with my rectum like you said or something serious....I had 2 BMs yesterday. As soon as I got up, I headed to the toilet then without much waiting and straining, I had a BM. But felt no urge though. The stool was half hard and half soft.Then about an hour later, I felt urge, so went to toilet. Large amount of very soft (floating) stool came out. It probably took about 1 second to get the whole thing to come out.I was so happy after that as you can guess because this is the first time I felt urge since last Feb.Today, I got up in the morning and went to toilet, I waited for about 30 min but nothing came out. So I just went to work. Then about an hour later, I felt urge again. Went to toilet and had normal BM. No straining, no hard stool.Why am I suddenly having normal BM with urge??? I guess it's the food I took last night and the night before yesterday. In both night, I ate small amount of raw fish. Large amount of raw fish usually cause acute diarrhea with me. So I guess these raw fish made my colon work faster.I think you don't feel proper urge when you have very liquid stool or diarrhea because this won't expand rectum.Also hard stool won't expand rectum neither unless you wait until lots of hard stool comes down to rectum. I guess these are why I was not able to feel the urge when I had hard stool or liquid stool.I still felt no urge even when I had soft stool. I guess that's because I was under this bowel retraining. My usual BM time is between 8 and 10 in the morning. But now I go to toilet as soon as I get up in the morning around at 6:30. So I get up, then go to toilet and wait for the thing to come out. I think as soon as stool comes down to rectum, I push it out. So there is no time for the stool to expand rectum to give me the urge.I guess if I keep doing this bowel retraining, I think I would be able to feel the urge as soon as I get up. I guess my training is not complete yet so the stool is not coming down to rectum at the time I want (6:30 am).


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## Kathleen M. (Nov 16, 1999)

Glad to hear this!I think waiting for the urge rather than just making yourself go will help in that getting the urge retrained back in.Keep up the good work!


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## alpha66 (May 19, 2011)

Kathleen M. said:


> Glad to hear this!I think waiting for the urge rather than just making yourself go will help in that getting the urge retrained back in.Keep up the good work!


Yeah I think you are right.According to every bowel retrain instruction I can find says not to strain.Also they say to do either digital enema every day or fleet enema every 2 or 3 days if you can't go.I guess that means you are not supposed to defecate by straining unless you feel urge.I will wait until I feel the urge like you said and see how it goes.Thanks!


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## PD85 (Aug 19, 2010)

alpha66 said:


> Yeah I think you are right.According to every bowel retrain instruction I can find says not to strain.Also they say to do either digital enema every day or fleet enema every 2 or 3 days if you can't go.I guess that means you are not supposed to defecate by straining unless you feel urge.I will wait until I feel the urge like you said and see how it goes.Thanks!


Are you still taking the Metamucil? I find it can take a few days to really get going full force and find it's way into all my stools. Once there it makes things slip out real easy and not much wiping either. You can try altering the time of day you take it and see how that effects your morning timing. Unfortunately I have the opposite stool problem as you and Metamucil doesn't make me go any less







. Also gets me bloated.


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## alpha66 (May 19, 2011)

PD85 said:


> Are you still taking the Metamucil? I find it can take a few days to really get going full force and find it's way into all my stools. Once there it makes things slip out real easy and not much wiping either. You can try altering the time of day you take it and see how that effects your morning timing. Unfortunately I have the opposite stool problem as you and Metamucil doesn't make me go any less
> 
> 
> 
> ...


I am taking metamucil but seems like it's not helping....During the initial stage of my constipation (about 7 moths ago) Psyllium Husk worked great. Then it stopped working. I've been trying metamucil for about a month but I am not sure if I have to keep taking it.I think I have slow transit time. Maybe I should stop taking metamucil????


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## PD85 (Aug 19, 2010)

alpha66 said:


> I am taking metamucil but seems like it's not helping....During the initial stage of my constipation (about 7 moths ago) Psyllium Husk worked great. Then it stopped working. I've been trying metamucil for about a month but I am not sure if I have to keep taking it.I think I have slow transit time. Maybe I should stop taking metamucil????


Are you still just taking one serving? You can try one serving in the morning and one at night. You can even double it. And yes, you have to take it consistently every day to get long-term results.


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