How to manage fecal impaction?

From the Guidelines

Managing fecal impaction requires a systematic approach starting with manual disimpaction followed by medication therapy, as recommended by the most recent guidelines. For manual disimpaction, a healthcare provider should use a lubricated, gloved finger to break up and remove the hardened stool, as suggested by 1. This should be done gently to avoid rectal damage. Following manual removal, a cleansing enema such as sodium phosphate (Fleet) or mineral oil can help clear remaining stool.

Ongoing Management

For ongoing management, patients should take osmotic laxatives like polyethylene glycol (MiraLAX) 17 grams mixed in 8 ounces of water daily for 2-3 days, or lactulose 15-30 mL twice daily, as recommended by 1. Stimulant laxatives such as bisacodyl (Dulcolax) 5-10 mg orally or senna 8.6-17.2 mg at bedtime can also be effective, as suggested by 1. Patients should increase fluid intake to 2-3 liters daily, add fiber to their diet gradually, and engage in regular physical activity.

Prevention

Prevention is crucial and involves maintaining adequate hydration, consuming 25-30 grams of fiber daily, establishing regular bowel habits, and promptly responding to the urge to defecate. Fecal impaction occurs when hard stool accumulates in the rectum, often due to chronic constipation, dehydration, or immobility, and can lead to complications like bowel obstruction if left untreated. The management of fecal impaction involves disimpaction, usually through digital fragmentation and extraction of the stool, followed by the implementation of a maintenance bowel regimen to prevent recurrence, as recommended by 1.

Key Considerations

• Increase fluid intake to 2-3 liters daily
• Add fiber to the diet gradually
• Engage in regular physical activity
• Establish regular bowel habits
• Promptly respond to the urge to defecate
• Consider medication therapy, such as osmotic laxatives or stimulant laxatives, as needed.

From the FDA Drug Label

Patients presenting with complaints of constipation should have a thorough medical history and physical examination to detect associated metabolic, endocrine and neurogenic conditions and medications. A diagnostic evaluation should include a structural examination of the colon Patients should be educated about good defecatory and eating habits (such as high fiber diets) and lifestyle changes (adequate dietary fiber and fluid intake, regular exercise) which may produce more regular bowel habits.

To manage fecal impaction, a thorough medical history and physical examination should be conducted to detect any underlying conditions. A diagnostic evaluation, including a structural examination of the colon, is also necessary.

• Education on good defecatory and eating habits is crucial, including a high fiber diet and lifestyle changes such as adequate dietary fiber and fluid intake, and regular exercise.
• The use of polyethylene glycol 3350 or lactulose may be considered to soften the stool and increase the frequency of bowel movements, but the dosage and administration should be determined by a physician. 2 3

From the Research

Management of Fecal Impaction

To manage fecal impaction, several treatment options are available, including:

• Polyethylene glycol (PEG) with or without electrolytes 4, 5
• Lactulose 6, 7
• Combination of PEG with electrolytes and sodium picosulphate 8

Treatment Options

The following treatment options have been studied:

• Polyethylene glycol (PEG) with or without electrolytes has been shown to be effective in treating fecal impaction in both adults and children 4, 5
• Lactulose has also been shown to be effective, although it may not be as effective as PEG in some cases 6, 7
• A combination of PEG with electrolytes and sodium picosulphate has been shown to be effective in disimpacting children with severe constipation in a suburban clinic setting 8

Efficacy and Safety

The efficacy and safety of these treatment options have been studied, with results showing that:

• PEG with or without electrolytes is generally well-tolerated and effective in treating fecal impaction 4, 5
• Lactulose is also well-tolerated, but may have a slower response time compared to PEG 6, 7
• The combination of PEG with electrolytes and sodium picosulphate has been shown to be safe and effective in disimpacting children with severe constipation 8

Comparison of Treatment Options

Comparisons of these treatment options have been made, with results showing that:

• PEG with or without electrolytes may be more effective than lactulose in treating fecal impaction 4, 7, 5
• Lactulose may be a good alternative to PEG in the treatment of fecal impaction in constipated children 6