From the Guidelines
After manual disimpaction, patients should follow a comprehensive aftercare regimen to prevent recurrence and promote bowel health, starting with increasing fluid intake to at least 8-10 glasses of water daily and adopting a high-fiber diet (25-30g daily) including fruits, vegetables, and whole grains, as recommended by the NCCN Palliative Care Panel 1. To prevent recurrence of constipation and promote bowel health, the following measures should be taken:
- Increase fluid intake to at least 8-10 glasses of water daily
- Adopt a high-fiber diet (25-30g daily) including fruits, vegetables, and whole grains
- Take a stool softener like docusate sodium (100mg twice daily) for 1-2 weeks
- Consider a daily osmotic laxative such as polyethylene glycol (17g in 8oz water once daily) for 2-4 weeks or as directed by the healthcare provider
- Establish a regular toileting schedule, preferably after meals when the gastrocolic reflex is strongest
- Use proper positioning during bowel movements by elevating feet on a small stool and leaning slightly forward
- Engage in regular physical activity for at least 30 minutes daily to stimulate bowel motility
- Monitor bowel movements for consistency and frequency, aiming for soft, formed stools every 1-3 days These measures help maintain proper stool consistency and bowel function by promoting adequate hydration, providing necessary fiber bulk, and supporting natural peristalsis, thereby preventing the hard, dry stool accumulation that leads to impaction, as supported by the NCCN guidelines 1. Additionally, the NCCN recommends considering 0.15 mg per kilogram of body weight of methylnaltrexone every other day (no more than once/day) for patients experiencing constipation that has not responded to standard laxative therapy 1. It is essential to note that the management of constipation should be individualized, and the healthcare provider should assess the cause and severity of constipation and treat any underlying conditions, such as hypercalcemia, hypokalemia, hypothyroidism, and diabetes mellitus, as recommended by the NCCN guidelines 1.
From the Research
Manual Disimpaction Aftercare
There are no research papers directly related to manual disimpaction aftercare among the provided studies. However, the studies discuss the management of constipation and the effectiveness of different treatments.
Constipation Management
- The study 2 compares the effectiveness of psyllium and docusate sodium in treating chronic constipation, finding that psyllium is superior in softening stools and increasing stool water content.
- The study 3 reviews the use of docusate for constipation in older people, concluding that there is a lack of evidence to support its effectiveness, and that psyllium and sennosides may be more effective alternatives.
Treatment Efficacy
- The study 2 found that psyllium increased stool water content, stool water weight, and total stool output, and improved bowel movement frequency compared to docusate sodium.
- The study 3 found that docusate did not show any benefits for constipation compared to placebo or other treatments like psyllium and sennosides.
- The study 4 discusses the removal of earwax, not directly related to manual disimpaction aftercare, but mentions the use of docusate-sodium-based preparation as a potential pre-treatment for cerumen impaction removal.