Consensus statement on bladder training and bowel training

Aim: This consensus statement synthesizes evidence to guide healthcare professionals on promoting consistent, cohesive and achievable bladder training for people with overactive bladder/urgency urinary incontinence and bowel training for those with urgency fecal incontinence. Methods: The Consensus Statement on Bladder and Bowel Training was developed by a sub-group of the International Continence Society Nursing Committee and an expert panel, who formed a virtual Consultation Group. Review of published research, expert opinion articles, policy statements, and voluntary professional group information identified existing recommendations, from which statements were formulated and organized. A modified Delphi process was used to reach consensus on each statement, involving three rounds of virtual consultation. Consultation Group members indicated agreement/disagreement with each statement. Statements, or changes, were accepted when consensus was reached, defined as agreement by 80% of the Consultation Group. Results: No universal definition of bladder training or bowel training was found, therefore a consensus definition was developed and agreed for each. Limited high quality studies of bladder training were identified and no studies investigating the use or effectiveness of bowel training for urgency fecal incontinence in adults. Broad-ranging evidence suggests both types of training should include four elements, personalized to individual need and situation: information and education; a prescribed voiding/evacuation regimen based on individually identified patterns of bladder or bowel functioning; progression of voiding/evacuation regimen; ongoing support and reinforcement. Conclusions: These consensus statements will support healthcare practitioners to design and deliver consistent bladder and bowel training. Improved evidence on mechanisms and effectiveness is needed to inform practice.