The morning routine at the Cottage Hospital was the same for every patient. Soaked nighttime diapers were disposed of, and bottoms were thoroughly wiped by the nurses. Thermometers were slid into reluctant rectums, lubricated first by a latex clad finger, inserted, and retracted precisely three times to stretch out the sphincter. Blood pressure and pulse was measured, before the thermometer was swiftly extracted and examined, and a record made of its reading. On Sundays, this was followed by the insertion of an enema nozzle.

The weekly cleanse was an important part of the treatment programme at the Cottage Hospital. The nurses made sure to protect their starched blue dresses with a thick rubber apron, cinched tightly at the waist, before they began their well-practiced routine. Patients were stripped of their white night gowns, which were replaced by a transparent rubber gown, open at the back. It was thought proper to afford the modesty of the gown, as the enemas were taken on the open ward, with the nurses administering to multiple patients at once.

The nozzle was inserted with the patient on their front, with their knees tucked underneath their stomach. The patient was encouraged to relax as the nurse first penetrated their rectum with two fingers, until they felt sufficiently loosened to begin feeding in the nozzle. Though patients initially found the double ended nozzle difficult to bear, they gradually became accustomed to its size, as the daily wearing of rectal plugs stretched their muscles. New patients, however, often required a little coaxing to accept the large nozzle, which the nurses provided by gently massaging the patient's rectum. Sometimes it was necessary to call the doctor, who could prescribe a muscle relaxant or order a more intensive course of dilation therapy.

Groans of discomfort echoed through the ward as the bulbs were inflated. They were hushed by the nurses, who quickly attached the hose and released the liquid. The patient was left alone while the canister of solution filled them, and the nurses turned their attention to the next patient. Privacy screens and potties were erected beside each bed while the patients retained the cleansing solution for ten minutes. Patients very quickly learned that it was better not to complain, as drawing the attention of the nurses could only result in an embarrassing examination of their genitalia. Erect cocks were commented upon and stroked, as were swollen clitorises. The patient was always supervised during the expulsion of the enema and was expected to present their bottom for inspection afterwards.

Most patients submitted willingly to their cleansing. They recognised the nurses’ rubber aprons as a sign of what was to come and allowed themselves to be maneuvered into position. They followed the instructions issued by the nurses, bearing down or relaxing when told to, and silently endured comments on the nature of the excrement leaving their body. When they presented their bottom for inspection, they were praised for their cleanliness, and gently oiled for their diapering. Less cooperative patients were moved to the behavioural therapy suite, where they could be safely restrained for their enema.

On non-cleansing days, the patient’s rectal temperature was followed by anal dilation therapy. A syringe of lubricant was squeezed into the patient’s rectum before a silicon plug, size dependent on the needs of the individual, was inserted. The nurses observed the reactions of the patients to this insertion, taking a note of those who became erect, and using their finger to detect lubrication in vaginas. Some of the male patients were already constrained in chastity cages, and whimpered as their erection was compressed. Once their dilators were in place, the patient was oiled, powdered, and pinned into their first diaper of the day. Re-usable cloth diapers were preferred for daytime wear, which necessitated the wearing of red, rubber pants.

The red rubber pants matched the large bib tied around the neck of each patient for breakfast. For all patients, breakfast comprised of a warm bottle of milk, followed by a thick porridge, eaten in bed. Some patients were permitted to feed themselves, while others were spoon fed by the nurses. Each patient was then given a spoonful of stool softener, which was taken at every meal.

Mealtimes at the Cottage Hospital were designed to keep the bowel movements of patients regular and predictable. Their high fiber content ensured at least one bowel movement a day, usually in the late morning. Rectal dilation also helped to delay this, as the patients were quite firmly plugged for the first few hours of the day. There were exceptions, especially among patients who had been resident at the hospital for some time. These patients often messed in their sleep or as soon as they awoke. They were subjected to a humiliation demonstration by the nurses, who instructed them out of bed, where their saggy bottoms were scrutinised before they were taken away to be cleaned. The patient was paraded down the corridor, their soiled diaper visible to all, before they were hosed clean.

After breakfast, the patients were dressed for their morning activities. All patients, regardless of their sex, were dressed in feminine clothing. A short dress, with puffed sleeves and a delicate peter pan collar, was the standard uniform for most. The outfit was completed with a matching diaper cover, extensively frilled on the bottom, which had extra padding between the legs. As a result, the patient could not escape the feeling of being contained in a very thick diaper, which parted their legs just enough to make walking difficult, which was already an awkward experience with an anal dilator in place.

However, not all patients were attired the same. Some patients, further on in their rehabilitation therapy, had been assessed as mature, and dressed accordingly. They wore structured rubber brassieres, which shaped their chest into points, and form fitting rubber girdles. Over this they wore a tight-fitting pencil dress, which clung to their cinched waist, and accentuated their padded bottom, barely contained by the girdle. Their attire was in sharp contrast to those who had been assessed as infantile, who were immediately recognisable by their bonnets. Infantile patients were often dressed only in their bonnet and rubbers, with a bib tied permanently round their neck.

Once the patient was dressed, they took part in etiquette activities. These ranged from embroidery to tea parties with dolls and teddy bears. Those classified as mature began their preparations for leaving the hospital and were trained in the domestic arts which would be expected of them in the next stage of their rehabilitation.

After a few hours of activities, it was time for the extraction of their dilators. This took place in a private treatment room, where the patient was stripped, and dressed in a transparent, rubber gown. They were then restrained to an exam table, with their legs elevated and secured into stirrups either side of the table. Their diaper was unpinned, and they were encouraged to bear down and push out the plug. It was common for patients to immediately soil themselves after the plug’s removal, while still restrained to the table. The humiliation of these patients was compounded by the nurses, who asked them to try to 'hold in' their 'poopoo' even when it was clear they couldn't. Those who managed to control themselves were moved to a potty and instructed to make their ‘pushies’. They were supervised by a nurse who gave them verbal encouragement to 'bear down' and praised them for making their 'poopies'. They were then instructed to bend over and have their bottoms wiped, before being changed into a fresh diaper in preparation for their nap.

If a patient could not pass stool within 15 minutes, the doctor was called to examine them. This was often the case for new patients, who were still adjusting to the hospital’s routine. Generally, the doctor performed a rectal exam, followed by the insertion of suppositories. The patient was pinned back into their nappies and restrained to the exam table until they had messed. This treatment was usually heavily objected to, as patients begged to be allowed to use the potty. Those who did this were silenced with a pacifier, and supervised by the doctor who encouraged them to 'make a big poo poo' if they wanted to avoid their bottom being filled with a a large soapy enema. Occasionally, it was decided that the patient would benefit from a more intensive treatment, and they were moved to the behavioural therapy suite.