From the Guidelines
Overflow diarrhea is a condition where liquid stool leaks around an impacted mass of hardened feces in the rectum, often requiring manual disimpaction, enemas, or suppositories for treatment, as well as oral laxatives like polyethylene glycol to soften the stool. This condition occurs when severe constipation leads to a fecal impaction that blocks the intestine, but watery stool from higher in the digestive tract flows around this blockage. According to the guidelines for the investigation of chronic diarrhoea in adults by the British Society of Gastroenterology 1, faecal impaction with overflow diarrhoea should be considered especially in the elderly, and clinical judgement rather than marker studies is recommended to confirm this diagnosis.
The primary treatment involves removing the impacted stool, which may require manual disimpaction by a healthcare provider, followed by enemas or suppositories. Oral laxatives like polyethylene glycol (MiraLAX) at a dose of 17g mixed in 8 ounces of water daily can help soften the stool. After resolving the impaction, preventing recurrence is essential through adequate fluid intake (at least 6-8 glasses of water daily), increased dietary fiber (25-30g daily), regular physical activity, and sometimes maintenance laxatives.
Key considerations in the diagnosis of overflow diarrhea include:
- Clinical presentation of diarrhea symptoms despite underlying severe constipation
- Presence of abdominal or rectal masses that may lead to the diagnosis of overflow diarrhoea, as noted in the ESMO clinical practice guidelines for diarrhoea in adult cancer patients 1
- Importance of proper diagnosis for effective treatment, as overflow diarrhea can be misleading
- Use of radiological imaging to investigate suspected abdominal or rectal masses
- Performance of rectal examination to exclude perianal abscess formation and detect blood or mucus in the stool.
Overall, proper diagnosis and treatment of overflow diarrhea are crucial to prevent complications and improve patient outcomes, and should be guided by the most recent and highest quality evidence, such as the guidelines from the British Society of Gastroenterology 1 and the ESMO clinical practice guidelines 1.