From the Guidelines
Fecal impaction should be treated with digital fragmentation of the stool, followed by enema or suppository to facilitate its passage through the anal canal, as recommended by the most recent guidelines 1. The primary approach to treating fecal impaction is to soften and remove the impacted stool, followed by preventing recurrence.
Treatment Approach
- For distal fecal impaction, digital fragmentation of the stool, followed by enema (water or oil retention) or suppository, is the recommended treatment approach 1.
- In cases of proximal fecal impaction, lavage with polyethylene glycol (PEG) solutions containing electrolytes may help to soften or wash out stool 1.
- If these measures are ineffective, or if symptoms are severe, a healthcare provider may prescribe stronger laxatives or perform manual disimpaction, which might involve using lubricating gels and manually breaking up the stool, or administering enemas 1.
Prevention of Recurrence
- After the impaction is resolved, prevent recurrence by increasing fluid intake to at least 8 glasses of water daily, consuming 25-30 grams of fiber per day, and engaging in regular physical activity 1.
- Avoid medications that can cause constipation, such as certain pain relievers or antidepressants, if possible.
Enema Options
- The choice of enema depends on the patient's condition and the severity of the impaction, with options including normal saline, soap solution, osmotic micro-enema, hypertonic sodium phosphate, docusate sodium, bisacodyl, and retention enemas 1.
- Each type of enema has its own rationale for use and potential adverse effects, which should be carefully considered when selecting a treatment option.
Important Considerations
- Enemas are contraindicated for patients with neutropaenia, thrombocytopaenia, paralytic ileus, intestinal obstruction, recent colorectal or gynaecological 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.
- The treatment of fecal impaction should be individualized based on the patient's specific needs and medical history.
From the Research
Treatment Options for Fecal Impaction
The treatment for fecal impaction (FI) can vary depending on the severity of the condition. Some common treatment options include:
- Manual disimpaction or fragmentation 2
- Use of distal and/or proximal softening or washout procedures such as enemas and suppositories 2, 3
- Oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes 2, 4
- Surgical intervention in severe cases 2, 5
- Endoscopic disimpaction using a looped guidewire 6
Medication Therapy
Medication therapy can also be effective in treating fecal impaction. Some studies have shown that:
- A combined regimen of polyethylene glycol and sodium picosulphate can produce fecal disimpaction in children with severe constipation and impaction 4
- Vegetable oil, Chinese traditional medicine, and enema can be used to treat severe fecal impaction 3
- Osmotic laxatives and enemas can be used to treat mild cases of fecal impaction 6
Prevention of Recurrence
To prevent recurrence of fecal impaction, it is recommended to: