From the Guidelines
Patients should be educated to avoid self-disimpaction of stool due to the risk of injury to the rectum and anal tissues. According to the ESMO clinical practice guidelines for the diagnosis, assessment, and management of constipation in advanced cancer 1, key prevention measures include ensuring access to toilets, dietetic support, and managing known decrease in food intake. Optimised toileting, educating patients to attempt defaecation at least twice a day, usually 30 min after meals and to strain no more than 5 min, is also recommended 1.
Key Recommendations
- Increase fluid intake and add more fiber to the diet to help soften stool and make it easier to pass
- Consider over-the-counter stool softeners like docusate sodium or osmotic laxatives such as polyethylene glycol (17g in 8oz water daily) for constipation relief
- For immediate relief, glycerin or bisacodyl suppositories can help stimulate bowel movement
- If these measures don't work within 2-3 days, or if severe pain, bleeding, or extreme constipation occurs, seek medical attention promptly
Important Considerations
- Manual disimpaction should only be performed by trained medical professionals as improper technique can lead to rectal tears, bleeding, or even perforation, which could require surgical intervention
- Healthcare providers have safe techniques and tools to remove impacted stool without causing damage
- Patients with swallowing difficulties or repeated faecal impaction may require rectal measures, such as enemas and suppositories, as the preferred choice of treatment 1
From the Research
Patient Education on Not Disimpacting Self
- The importance of patient education on not disimpacting self is highlighted by a case report of a patient who suffered a cardiac arrest and ultimately death due to rectal manipulation during disimpaction 2.
- It is essential to educate patients on the risks associated with self-disimpaction and the importance of seeking medical attention if they experience constipation or fecal impaction.
- Patients can be advised to use over-the-counter (OTC) products such as polyethylene glycol (PEG) or psyllium, which have been shown to be effective in treating constipation 3, 4, 5.
- Fiber supplementation, particularly with psyllium, has been found to be effective in improving constipation symptoms, with higher doses (>10g/d) and longer treatment durations (≥4 weeks) appearing to be optimal 6.
- Patients should be educated on the proper use of these products, including the importance of adequate hydration and the potential for adverse effects such as diarrhea, nausea, and bloating 3, 4, 5.
- Healthcare providers should also emphasize the importance of close monitoring and adequate analgesia for patients undergoing disimpaction procedures, especially those with significant stool burdens 2.