What is the treatment for overflow diarrhea?

From the Guidelines

The treatment for overflow diarrhea primarily involves addressing the underlying fecal impaction that causes it, and the most effective approach is to remove the impacted stool through disimpaction methods such as digital removal, enemas, or oral laxatives like polyethylene glycol (PEG) 1.

Key Considerations

• The first step in managing overflow diarrhea is to rule out impaction, especially if diarrhea accompanies constipation, as this indicates overflow around an impaction 1.
• Treatment should focus on clearing the impaction and establishing a maintenance bowel regimen to prevent recurrence, rather than using anti-diarrheal medications which can worsen the underlying problem by further reducing gut motility.
• A maintenance bowel regimen typically includes daily osmotic laxatives such as MiraLAX or lactulose, and stool softeners like docusate sodium may be added 1.

Supportive Measures

• Increasing dietary fiber (aim for 25-30g daily) and ensuring adequate hydration (at least 6-8 glasses of water daily) are essential supportive measures.
• Regular physical activity is also recommended to help manage constipation and prevent recurrence of overflow diarrhea.
• Avoiding medications that can cause constipation, such as opioids, certain antidepressants, and calcium channel blockers, is crucial if possible 1.

Monitoring and Adjustment

• Continuous monitoring of the patient's condition and adjustment of the treatment plan as needed is important to ensure effective management of overflow diarrhea and prevention of complications.
• If constipation persists, reassessment for cause and severity of constipation, and consideration of adding other laxatives or prokinetic agents may be necessary 1.

From the FDA Drug Label

STOP USE AND ASK A DOCTOR IF • you have rectal bleeding or your nausea, bloating, cramping or abdominal pain gets worse. These may be signs of a serious condition. • you get diarrhea • you need to use a laxative for longer than 1 week The treatment for overflow diarrhea is not explicitly stated in the provided drug label. However, it does mention to stop use and ask a doctor if you get diarrhea.

• The label advises to consult a doctor in case of diarrhea, implying that medical guidance is necessary for appropriate treatment.
• It is essential to seek medical attention for proper evaluation and treatment of overflow diarrhea, as the label does not provide direct treatment instructions 2.

From the Research

Treatment for Overflow Diarrhea

The treatment for overflow diarrhea can be complex and depends on the underlying cause.

• In cases of fecal impaction, manual removal can be successful in 80% of cases, while endoscopy and surgery may be necessary in severe cases 3.
• For infectious diarrhea, oral rehydration therapy (ORT) is the principal treatment modality, and antimicrobial agents may be necessary for certain types of infections, such as shigellosis and amebiasis 4.
• In cases of dehydration due to diarrhea, fluid therapy can be used, with oral rehydration solutions (ORS) recommended for mild to moderate dehydration, and intravenous fluids for severe dehydration 5.
• It's also important to note that antidiarrheal agents do not provide additional benefit in the management of infectious diarrhea, and probiotics have shown some benefit in the treatment of acute diarrhea, but their use is not yet widely recommended 4.

Management of Underlying Conditions

• For conditions such as pelvic floor dyssynergia, biofeedback has been shown to be an effective treatment, with benefits lasting at least 2 years 6.
• In cases of constipation, laxatives may be used, but biofeedback has been shown to be superior in treating normal transit constipation due to pelvic floor dyssynergia 6.
• For children with diarrhea, oral rehydration therapy and dietary manipulations are important aspects of management, and antimicrobial therapy may be necessary for certain types of infections 4.

Additional Considerations

• Early identification of fecal impaction with atypical symptoms, such as overflow diarrhea, is crucial to provide proper emergency management 3.
• A safe and noninvasive treatment method should be chosen, especially for elderly patients with fecal impaction 3.
• Appropriate feeding during diarrhea is recommended for nutritional recovery and to prevent body weight loss 4.