What is the treatment for fecal impaction?

From the Guidelines

Fecal impaction treatment should involve disimpaction through digital fragmentation and extraction of the stool, followed by the implementation of a maintenance bowel regimen to prevent recurrence. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of prompt intervention to relieve the hardened stool blockage in the rectum 1.

Key Considerations

• Manual disimpaction is often the first-line treatment, where a healthcare provider lubricates a gloved finger and gently breaks up and removes the impacted stool.
• This may be followed by an oil retention enema (such as mineral oil) to soften remaining stool, held for 15-20 minutes before expulsion.
• Oral medications include polyethylene glycol (MiraLAX, 17g in 8oz water daily), docusate sodium (100mg twice daily), or lactulose (15-30ml daily) 1.
• For severe cases, higher-volume enemas like Fleet Phosphate or tap water enemas may be necessary.
• After the impaction is resolved, prevention is crucial through adequate hydration (6-8 glasses of water daily), fiber intake (25-30g daily), regular physical activity, and sometimes maintenance laxatives.

Potential Complications

• Fecal impaction can lead to complications like bowel perforation or obstruction if left untreated.
• Other potential complications include urinary tract obstruction, perforation of the colon, dehydration, electrolyte imbalance, renal insufficiency, faecal incontinence, decubitus ulcers, stercoral ulcers, and rectal bleeding 1.
• Underlying causes like medication side effects, neurological disorders, or anatomical issues should be addressed to prevent recurrence.

From the FDA Drug Label

USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days The answer to Fecal 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 fecal impaction.
• Fecal impaction is a more severe condition that may require different treatment approaches. The FDA drug label does not answer the question.

From the Research

Fecal Impaction Treatment Options

• Manual disimpaction or fragmentation of the rectum 3
• Use of distal and/or proximal softening or washout procedures such as enemas and suppositories 3, 4, 5
• Oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes 3, 6
• Pulsed irrigation enhanced evacuation device for severe fecal impaction 7
• Surgical intervention in severe cases, such as ulceration and perforation leading to peritonitis 3, 5

Post-Treatment Evaluation and Prevention

• Colonic evaluation by flexible sigmoidoscopy, a colonoscopy, or a barium enema after the fecal impaction resolves 3
• Evaluation of causes and creation of a preventive therapy plan 3, 4, 5
• Increasing dietary fiber content to 30 gm/day, increased water intake, and discontinuation of medications that can contribute to colonic hypomotility to prevent recurrence 5

Efficacy of Polyethylene Glycol

• Polyethylene glycol with or without electrolytes is more efficacious than placebo for the treatment of functional constipation 6
• Polyethylene glycol is as efficacious as enemas in fecal impaction and avoids the need for hospital admission 6
• Polyethylene glycol is well tolerated by patients, mainly when administered without electrolytes 6