What is the treatment for a low-volume stool in the colon and rectum, also known as constipation (bowel obstruction)?

From the Guidelines

To treat small volume stool in the colon and rectum, the most effective approach is to increase fluid intake and add fiber to the diet, and if necessary, use osmotic laxatives like polyethylene glycol or stimulant laxatives like bisacodyl, as recommended by the most recent and highest quality study 1. When managing small volume stool, it's essential to consider the patient's overall health and medical history. The study published in Gut in 2020 1 provides guidance on the management of constipation, which can be applied to treating small volume stool.

Key Recommendations

• Increase fluid intake to 8-10 glasses of water daily to help soften the stool and make it easier to pass.
• Add more fiber to the diet through fruits, vegetables, and whole grains to promote regular bowel movements.
• Use osmotic laxatives like polyethylene glycol (17g daily) or stimulant laxatives like bisacodyl (5-10mg orally) to help draw water into the intestines and stimulate contractions.
• Consider using stool softeners like docusate sodium (100mg twice daily) to aid in water penetration of the fecal mass.
• For immediate relief, glycerin suppositories or small-volume enemas (Fleet enema) can help evacuate the rectum.

Important Considerations

• Regular physical activity can also promote bowel motility and help prevent constipation.
• If symptoms persist beyond two weeks, or if you experience severe abdominal pain, bleeding, or significant weight loss, consult a healthcare provider as these could indicate a more serious condition requiring medical evaluation.
• The use of enemas and suppositories should be guided by a healthcare provider, especially in patients with certain medical conditions or taking certain medications, as highlighted in the study published in Annals of Oncology in 2018 1.

From the FDA Drug Label

USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days Uses for relief of occasional constipation (irregularity). This product generally produces bowel movement in 12 to 72 hours. Uses relieves occasional constipation (irregularity) generally produces bowel movement in 12 to 72 hours

The treatment for small volume stool in the colon and rectum may involve the use of laxatives or stool softeners, such as:

• Polyethylene glycol (PO) 2: to relieve occasional constipation
• Psyllium (PO) 3: for relief of occasional constipation
• Docusate (PO) 4: to relieve occasional constipation These medications can help produce a bowel movement and relieve constipation. However, it is essential to follow the recommended dosage and usage instructions.

From the Research

Treatment Options for Small Volume Stool in the Colon and Rectum

• Increasing dietary fiber intake, particularly soluble fibers such as psyllium, can help improve stool volume and consistency 5, 6
• Polyethylene glycol (PEG), or macrogol, is a laxative that can help increase the volume of intestinal contents and facilitate transport and evacuation 5
• The combination of psyllium and PEG may be an effective therapeutic option for patients with chronic constipation 5
• Psyllium has been shown to be superior to docusate sodium in increasing stool water content and improving laxative efficacy in patients with chronic constipation 6

Management of Constipation

• Ensuring adequate intake of dietary fiber and water is essential for preventing and managing constipation 5
• Over-the-counter laxatives or bulking agents may be necessary to restore a satisfactory bowel habit in cases of occasional constipation 7
• Lifestyle and dietary modifications may be required to manage constipation and prevent future episodes 7

Definition and Diagnosis of Constipation

• Occasional constipation can be defined as intermittent or occasional symptomatic alterations in bowel habit, including a reduction in bowel movement frequency and/or difficulty with stool passage 7
• A thorough understanding of the multifactorial nature of constipation, including alterations in bowel habit, perception of symptoms, and potential responsiveness to treatment, is necessary for accurate diagnosis and management 7