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Bowel Movement Program by Annette Bisanz

DonK4's picture
Posts: 4
Joined: May 2010

I was diagnosed with rectum cancer back in June of 2009 and went through chemo,radiation and then surgery. After six months I had reversal surgery (three weeks ago). I am feeling pretty good except that I feel like I need to have a bowel movement 24/7. My doctor put me on a high fiber diet but it was not really helping. I am still on the toilet all day long.

I started following Annettes "Bowel Movement program"; drinking two ounces of water with one teaspoon of Metamucil after one meal and it seems to slow things down. My question is that she wants you to add a teaspoon of Metamucil every 3-5 days. Is that in the same two ounces of water or at a different meal? When do I stop or is this a life long thing?

She also recommends "Bowel Training" which is drinking prune juice before a big meal and then hot liquid right after the meal. How long should I keep this up? has anyone tried it?

I am looking for any advice on how I can get rid of the urge to have a bowel movement all day long. I force myself to get out of the house but it seems that I can't enjoy myself at all. It has only been three weeks but if anyone has suggestions or a best practice I would really appreciate it.

Annabelle41415's picture
Posts: 6652
Joined: Feb 2009

Had a reversal in November and at first the bathroom was my only close companion. Not only was the urge to go constant, having a bowel movement 30-35 times a day was normal for me. High fiber diet has worked somewhat with me taking a tablespoon of metamucil a day plus I eat a well balanced diet. Still going about 15 or more times a day but it is more in a cluster (meaning it's all within about 1 1/2 hours) and then I'm cleaned out. It doesn't seem that I can completely void all within just a couple of times so it's a little at a time during that time span. I'm able to go out during the day most of the time without having any problems, but occasionally it hits me and I need to find a bathroom fast. Still having a hard time always keeping control too. I do take about 2 ozs of prune juice everyday though. Hate being constipated so would rather have looser stools than constipated or hard stools. It should get better in time and I'm hoping that the longer it is for me, that my frequency gets less. Doctor told me it could take up to two years for the bowels to adjust.


DonK4's picture
Posts: 4
Joined: May 2010

Thanks for getting back with me. I am going to lick this thing. I heard it takes at least 6 months to a year (if not longer). I force myself to do things daily but I am so uncomfortable. I know there are so many people out there in worse shape then me. I am lucky to be doing as well as I am after three weeks.

Did you follow the diet I was speaking about? Prune juice is part of the diet.

Thanks again.

Annabelle41415's picture
Posts: 6652
Joined: Feb 2009

No I didn't do her diet, but it seems that I do some of the things she suggested. Yes the immodium does help too, but have a problem taking them as if I only take 1/4 of a pill it overworks with me and then get constipated. You need to do what will work for you and it has been 6 months for me, but I'm still working on getting a happy medium. It might take me another 6 months to a year, but most days I'm fine and the bathroom issues at night are bearable. Good luck and keep me up to date on how you are doing.


jillpls's picture
Posts: 241
Joined: Mar 2008

I had the same thing in 2007. By week 5 I was able to enjoy and dance at my daughters wedding. It took using immodium but it worked. Be patient and it will clear up.

Posts: 810
Joined: Nov 2009

it gets better, give it more time, I had my reversal in September and within a few months I was doing so much better and managing my bathroom breaks, I still have times when I am going a lot however this is about once a week that I feel I need to stay close to a bathroom.

Posts: 124
Joined: Jan 2008

I had my take down surgery in November 2008 - the first few months were the worst - things got much better after that; though not perfect. My big improvement wasn't until August 2009; and then for some unknown reason, after hernia repair surgery in November 2009 I started having major problems again. As you said - feeling like I had to go all the time, burning sensation, etc.

I saw my surgeon yesterday to talk to her about it. She said to take 1-2 fiber pills every night with dinner and come back in 6 weeks if it didn't help. In the early weeks of my take down surgery I tried fiber pills, but I was taking them along with stool softeners and I thought they sped things up too much; so I dropped them from my program. I've since learned there is soluble fiber and non-soluble fiber. The soluble fiber is the powder supplements you take; non-soluble fiber is like fresh veggies. The soluble fiber is meant to bulk up your stool so you have bigger (and hopefully less frequent) poops. The non-soluble fiber, for me at least, just keeps things moving along. I hope I've got this right!

So I'm trying fiber pills again - but just 1 a night for now as I've learned my system is pretty sensitive to any sort of change. I'm also going to schedule an appointment with a Naturopath to discuss possible diet changes I need to make. I asked my surgeon about this and she basically said "knock yourself out - just take what they say about food allergies with a grain of salt". I'm learning from this whole cancer journey that each doctor has their own specialty. Surgeons cut. Oncologists kill chemo with cancer. Radiologists use radiation. Etc. And as strange as this seems to me, they don't usually have much more than a basic understanding of what the other specialties do.

When it comes to take down surgeries, everyone's experiences vary greatly - from great success to great failure and everything in between. You are still so early in your recovery that I wouldn't worry about how you feel right now (other than I know you feel like crap when going through this). I'm pretty confident in telling you that things will get better in the next few months. It is a LOT of trial and error about what foods you can and can't eat; when are the best times to eat; fiber and/or how much fiber to take. My surgeon told me I will probably need to take fiber for the rest of my life. She also said if there's an event I want to attend and I'm worried about bowel movements, just give myself an enema for that day. I asked her if this was safe since I have no rectum and she said yes, just be careful. Okey dokey then.

My accupuncture therapist has put me on probiotics - you've probably heard about those too - Activia yogurt and all. She gave me an over the counter pill that's really tiny and she says is more effective than the probiotics you get in Activia. So I'm trying that too - 1 a day to try to add good bacteria back in my colon. She also said I'll probably have to take probiotics for the rest of my life. On a side note - the accupuncture hasn't helped with my bowel movements but it has helped a lot with my anxiety issues, sleep issues and general fatigue.

So welcome to the world of trial and error - and hopefully some success. If you haven't checked out the UOAA web-site, they now have a sub-group on temporary ileo's and take downs. Here's a link if you need it. There may be some information there that is useful as well. http://www.uoaa.org/forum/viewforum.php?f=25

DonK4's picture
Posts: 4
Joined: May 2010

Thank you so much for sharing your experience. I agree with you about specialty doctors. They only know so much and it is up to us to find out truely what is going to work for our bodies. I do a lot of research and here are some great links including the Bowel Program I am following. It seems to be working and its been only three weeks. Good luck and keep in touch.




And here is Annette Bisanz's Bowel Program:

Quality of Life After Colorectal Surgery Annette Bisanz, B.S.N., M.P.H.

----------Following colorectal surgery, there may be a change in bowel function due to the change in the anatomical structure of the colon or rectum, or both. This may necessitate a bowel management program that is based on the same basic principles but needs to be individualized for each person. There is all the reason in the world to believe that your bowels can be managed after colorectal surgery.

----------These are the prerequisites for managing bowel control: · Be committed to the program and be willing to follow specific directions. Seek guidance from a professional when you are not achieving the goals of your program.

------- Keep your sense of humor. Following colorectal surgery, many people find themselves having several stools per day. Bowel movements may be clustered at certain times of the day, and often there is an inability to fully empty at one specific time. The normal frequency of bowel movements in a healthy population varies from 3 bowel movements per day to 3 per week.

-----The goal is to return to no more than 3 bowel movements per day. Transit Time of Food Through the Gastrointestinal TractEating a large meal or drinking a hot liquid will cause a normal peristaltic push down in the gastrointestinal (GI) tract.

---- When frequent bowel movements occur, drink less fluid with your meals, drink more fluids between meals, and avoid hot liquids. Medicinal Fiber to Change the Transit TimeIf you are having frequent stools, then introducing psyllium, a medicinal fiber also known as Metamucil, can slow down transit through the GI tract.

-----Most people take psyllium for constipation or to speed up transit time through the GI tract; however after colorectal surgery, your goal will be to slow down the transit time. To do this, take the prescribed amount of fiber right after a meal in very little fluid, approximately 2 oz., and no more fluid for 1 hour immediately after a meal. This allows the fiber to act like a sponge in the GI tract, soaking up excess fluid in the digestive system and thus slowing things down. One teaspoon should be taken after the same meal each day for 3 to 5 consecutive days. Then increase to 1 teaspoon psyllium 2 times per day.

-------Gradually increase the fiber by 1 teaspoon every 3 to 5 days until the GI tract transit time slows down a bit. Bowel TrainingOnce your stools become better formed and the transit time has been slowed down, the next step is bowel training, with the goal of emptying the colon fully at an expected time each day. Pick a meal of your choice around which you'll bowel train yourself. Bowel training is done around a meal since a big meal causes a push down the GI tract to make room for the food taken in.

-------Choose a time when you can consistently follow the program.
Then, · Before that meal drink 1 oz. of prune juice. · Eat the big meal.· Drink a hot liquid. If this does not produce results, you may try using a glycerin suppository after the hot liquid.· Do this for 3 straight days. If you don't empty as planned, substitute the glycerin suppository with 1/2 bisocodyl suppository. · If this is effective, stay with the program for 2 weeks and then stop using the suppositories. By this time, the stimulus for your bowel to empty will be the prune juice, big meal, and hot liquid. Adjusting the Bowel Management ProgramSince each person's body reacts a little differently, don't get discouraged if your program doesn't immediately help. Problem solving is the key to success, and little changes made after trying something for 3 days will help you determine what will work for you. Overall bowel management involves a gradual balancing of food, fluid, fiber, and medications.

_________Food: If your bowel is stimulated by a big meal, eat 1 big meal per day and 4 smaller meals. Certain foods affect people adversely, and you need to be aware of what you eat that may cause increased bowel movements. (High-fat and/or spicy foods seem to affect many people.) Fluid: Fluid with meals tends to increase peristaltic push-down. So, drink fluid in between meals instead of a large amount with meals and avoid hot liquids.

________Fiber: Adjust the amount of fiber gradually to determine how much fiber is required to slow down or speed up transit time through your GI tract and maintain soft, formed stool.
______Medications: If you are taking anitdiarrheal medications such as Lomotil or Immodium, as you gradually increase the amount of psyllium, try to decrease the amount of Lomotil/Immodium. Most people get good bowel control just by the use of fiber. However, keep yourself comfortable during the process of defining your maintenance bowel management program. Be patient with yourself. Remember, there is hope for bowel management, the goal being a high quality life after colorectal surgery. Next Issue: The Resource Review column will review the video "How your Bowel Works" by Annette Bisanz, B.S.N., M.P.H.

gowiththeflow's picture
Posts: 2
Joined: Nov 2016

Thank you for that advice Don ............... just what I needed to read.

cnchunter's picture
Posts: 1
Joined: Oct 2017

Since this is such an old site, wondering how you are doing at this point and whether you found any additional things that helped you stabilize your colon. I'm three weeks post-op for sigmoid resection (about a foot) and everything's going well except for the 24/7 BMs that keep me chained to the bathroom. Am just starting Bisanz's Bowel Program so too early to tell on that. Thanks for any info.



Trubrit's picture
Posts: 5339
Joined: Jan 2013

Don hasn't been on the site since 2010, so there's no knowing if he's here or.... well, you know. 

Why not start your own thread here   https://csn.cancer.org/forum/128   and others can join in the welcome and help answer any quesitons you have.


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andicat's picture
Posts: 10
Joined: Dec 2009

I had a rectal tumor removed in August 2009, no bag. With all my poop problems, I was wishing I did have a bag put in. Of course everybody said I was crazy, but things do get better. I put ground up flax seed on oatmeal in the morning and have a good bowel movement after that. I have small bowel movements during the day, but I can manage that. I usually have to stick around the house right after I eat. My problem now is because there are days I poop more than other days, my behind gets a bit raw. Any thoughts on a good ointment to use? I use PrepH or an aloe gel. They are OK but just wondering if there is anything more hardcore. And thanks for the book title. I'm going to see if my library has it. I look forward to reading it.

DonK4's picture
Posts: 4
Joined: May 2010

I have tried everything to help with the burning. You need to look for a barrier creme (Desitain, Balmax or Calmoseptine). I use zinc oxide (found in the baby section at the drug store)after every bowel movement. I also soak in a hot tub throughout the day. That seems to help. Anyone else have a suggestion?

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