From the Guidelines
For patients with pelvic organ prolapse experiencing persistent fecal loading despite colonic PegLyte washouts, the next step would be to consider a more comprehensive approach to bowel management, including a combination of oral osmotic laxatives, stimulant laxatives, and continued regular enemas, as well as addressing the underlying prolapse through referral to urogynecology or colorectal surgery for evaluation of surgical repair options 1.
Key Components of Management
- Implementing a scheduled bowel regimen with oral osmotic laxatives (such as polyethylene glycol 17 g daily) and a stimulant laxative (such as bisacodyl 10 mg daily or senna 8.6-17.2 mg daily) 1
- Continued regular enemas if needed
- Referral to urogynecology or colorectal surgery for evaluation of surgical repair options, as surgical options may be considered in patients with fecal incontinence and defecatory disorders who have failed conservative therapy 1
- Pelvic floor physical therapy to improve muscle coordination and function
- Dietary modifications including increased fiber (25-30g daily) and adequate hydration (2-3 liters daily) 1
Further Evaluation and Considerations
- The persistent fecal loading despite washouts suggests either a mechanical obstruction from the prolapse itself or significant colonic dysmotility, which may require further evaluation with defecography or colonic transit studies 1
- Manual disimpaction under appropriate analgesia may be necessary if there is significant impaction causing immediate symptoms
- Biofeedback therapy may be considered for patients with defecatory disorders, as it improves symptoms in more than 70% of patients 1
From the Research
Next Steps for Pelvic Organ Prolapse with Fecal Loading
- If a patient is still experiencing fecal loading with colonic PegLYte washouts, the next step would be to consider other management options for pelvic organ prolapse, as the current treatment is not effective in resolving the issue.
- According to 2, 3, 4, 5, 6, treatment options for pelvic organ prolapse include observation, pelvic floor physical therapy, pessary use, and surgery.
- The choice of treatment depends on the severity of the prolapse, the patient's symptoms, and their medical and surgical history.
- In patients with symptomatic prolapse, management options include conservative measures, pessary use, or surgical intervention, as stated in 2.
- Surgical interventions include native tissue transvaginal surgeries or a transabdominal (laparoscopic or robotic) approach with use of polypropylene mesh, as mentioned in 2.
- It is essential to consider lifestyle modifications, such as weight loss, and conservative measures, including pelvic floor muscle training, topical estrogens, and pessaries, as initial management options, as suggested in 3.
- The patient's preference and treatment goals should be taken into account when deciding on the best course of action, as emphasized in 2, 5.