From the Guidelines
Stool impaction treatment requires a systematic approach beginning with manual disimpaction for severe cases, followed by medication therapy. For manual disimpaction, a healthcare provider will use a lubricated, gloved finger to break up and remove the hardened stool, typically done with sedation or pain management if needed 1. After disimpaction, oral laxatives are essential, with polyethylene glycol (Miralax) being the preferred option, taken as 17g dissolved in 8oz of water once or twice daily until regular bowel movements resume. Alternatively, lactulose (15-30ml daily) or magnesium citrate (200-300ml as a single dose) can be used. Stimulant laxatives like bisacodyl (5-10mg) or senna (8.6-17.2mg) may be added for stubborn cases. Enemas such as mineral oil or sodium phosphate can help soften and evacuate impacted stool.
Key Considerations
- The use of suppositories and enemas is a preferred first-line therapy when a digital rectal examination (DRE) identifies a full rectum or fecal impaction 1.
- Enemas are contraindicated for patients with neutropenia or thrombocytopenia, paralytic ileus or intestinal obstruction, recent colorectal or gynecological surgery, recent anal or rectal trauma, severe colitis, inflammation or infection of the abdomen, toxic megacolon, undiagnosed abdominal pain, or recent radiotherapy to the pelvic area 1.
- Following successful disimpaction, prevention is crucial through increased fluid intake (at least 8 glasses of water daily), dietary fiber (25-30g daily), regular physical activity, and maintenance laxatives if needed.
Medication Options
- Polyethylene glycol (Miralax) is the preferred oral laxative option, taken as 17g dissolved in 8oz of water once or twice daily until regular bowel movements resume.
- Lactulose (15-30ml daily) or magnesium citrate (200-300ml as a single dose) can be used as alternative oral laxatives.
- Stimulant laxatives like bisacodyl (5-10mg) or senna (8.6-17.2mg) may be added for stubborn cases.
- Enemas such as mineral oil or sodium phosphate can help soften and evacuate impacted stool. This comprehensive approach works by softening the stool, increasing intestinal motility, and restoring normal bowel function while addressing the underlying causes of constipation, as recommended by recent guidelines 1.
From the FDA Drug Label
USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days The answer to stool impaction treatment is not directly addressed in the provided drug label for polyethylene glycol (PO) 2.
- The label mentions relief of occasional constipation, but does not specifically address stool impaction.
- Polyethylene glycol (PO) may help with constipation, but its effectiveness for stool impaction is not explicitly stated. Since the FDA label does not directly address stool impaction treatment, no conclusion can be drawn about its use for this specific condition.
From the Research
Stool Impaction Treatment Options
- Manual disimpaction or fragmentation, the use of distal and/or proximal softening or washout procedures such as enemas and suppositories, and oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes are common treatment options for fecal impaction of the rectum 3
- In severe cases, surgical intervention is necessary 3
- Post-treatment evaluation should include a colonic evaluation by flexible sigmoidoscopy, a colonoscopy, or a barium enema after the fecal impaction resolves 3
Treatment of Fecal Impaction with Polyethylene Glycol
- Polyethylene glycol with or without electrolytes is more efficacious than placebo for the treatment of functional constipation, either in adults or in pediatric patients, with great safety and tolerability 4
- Polyethylene glycol is as efficacious as enemas in fecal impaction, avoids the need for hospital admission, and is well tolerated by patients 4
- Disimpaction on polyethylene glycol plus electrolytes was achieved in 92% of children without additional interventions 5
Comparison of Treatment Options
- Polyethylene glycol plus electrolytes is significantly more effective than lactulose as maintenance therapy, both in efficacy in treating constipation and efficacy in preventing the recurrence of fecal impaction 5
- Mineral oil or warm water enemas can be used to treat fecal impaction 6
- Lifestyle modifications, such as scheduled toileting after meals, increased fluid intake, and increased dietary fiber intake, can also be used to treat constipation 6