From the Guidelines
Moderate to large fecal loading should not be left untreated as it can lead to severe complications such as bowel obstruction, fecal impaction, and decreased quality of life. The most recent and highest quality study, published in 2020 1, recommends a combination of stool softeners, laxatives, and increased fluid intake for treatment. For immediate relief, an osmotic laxative like polyethylene glycol (MiraLAX) at a dose of 17g mixed in 8 ounces of water once or twice daily is recommended, which can help stimulate intestinal transit and increase luminal fluid secretion.
Key Considerations
- This can be combined with a stimulant laxative such as bisacodyl (Dulcolax) 5-10mg orally or as a suppository for faster results, as suggested by the 2018 study 1.
- In more severe cases, an enema such as Fleet Phosphate Enema may be necessary, but it is essential to consider the potential risks and contraindications, such as neutropaenia or thrombocytopaenia, paralytic ileus, or intestinal obstruction.
- Maintaining regular bowel movements is crucial through increased dietary fiber (aim for 25-30g daily), adequate hydration (at least 8 glasses of water daily), and regular physical activity.
Treatment Options
- Osmotic laxatives: polyethylene glycol (MiraLAX) at a dose of 17g mixed in 8 ounces of water once or twice daily
- Stimulant laxatives: bisacodyl (Dulcolax) 5-10mg orally or as a suppository
- Enemas: Fleet Phosphate Enema, but consider potential risks and contraindications
Prevention of Future Complications
- Increased dietary fiber (aim for 25-30g daily)
- Adequate hydration (at least 8 glasses of water daily)
- Regular physical activity The reason treatment is necessary is that accumulated stool in the colon stretches the bowel, potentially weakening the muscles needed for normal bowel movements, creating a cycle of worsening constipation and increasing the risk of complications like hemorrhoids, anal fissures, or rectal prolapse, as highlighted in the 2020 study 1.
From the Research
Fecal Loading Treatment
- Moderate to large fecal loading should not be left untreated, as it can lead to complications and patient discomfort 2.
- Treatment options for fecal impaction include manual disimpaction, softening or washout procedures, and oral or nasogastric tube placement for polyethylene glycol solutions 2.
- In severe cases, surgical intervention may be necessary 2.
- Post-treatment evaluation should include a colonic evaluation to assess for any underlying conditions 2.
Consequences of Untreated Fecal Loading
- Untreated fecal loading can cause bowel symptoms in patients with regular bowel movements 3.
- Fecal loading may be a cause of symptoms in patients with functional bowel disorders, even if they do not have infrequent bowel movements 3.
- Dietary advice and laxative treatment can improve symptoms in patients with fecal loading 3.
Treatment Options for Constipation
- Polyethylene glycol (PEG) and lactulose are commonly used osmotic laxatives for treating chronic constipation 4.
- PEG is more effective than lactulose in outcomes such as stool frequency, stool form, and relief of abdominal pain 4.
- Low-volume same-day PEG preparation can result in similar bowel cleanliness compared to high-volume or low-volume split-dosing 5.