According to the Rome III criteria for constipation, a patient must have experienced at least 2 of the following symptoms over the preceding 3 months:

·       Fewer than 3 bowel movements per week

·       Straining

·       Lumpy or hard stools

·       Sensation of anorectal obstruction

·       Sensation of incomplete defecation

·       Manual maneuvering required to defecate

Bowel training can help to:

·       avoid constipation and fecal impaction

·       develop regular bowel habit as well as reduce fecal incontinence

Bowel training

·       Adequate fiber intake

·       Dietary fiber & liquid assisted formation of soft and formed stool which aids colonic transit. Adult should have 25g fiber intake daily.  Source of food includes: whole wheat, bran, vegetables, whole grains and fruits, etc

·       Adequate fluid intake

·       Unless contraindicated, adult should maintain 1.5-2L fluid intake (e.g. soup, water) daily to keep stools soft and formed

·       Regular bowel opening

·       Gastro-colic reflex usually occurred 30-60 minutes after meal and aids defecation. It is very important to have regular bowel habit at a regular interval.  For example, you can regulate bowel habit after breakfast

·       Regular exercise

·       Daily exercise promotes peristalsis

·       Posture

·       Squatting is the best position, when use toilet seat, proper posture includes

·       both feet support on the floor or foot-step

·       both arms rest on knees

·       leaning forward

·       Abdominal massage

·       Clockwise abdominal massage, starting from right lower abdomen up to ribs, then transverse under ribs and turn down to the left side (If suspects to have intestinal obstruction, abdominal mass, just having abdominal surgery or after radiotherapy, avoid abdominal massage)

·       Medicine

·       If all the above measures fails, consult doctor for drug treatment as temporarily relief e.g. laxative or enema