From the Guidelines
Treatment for fecal impaction typically begins with manual disimpaction, followed by enemas and oral medications to soften and evacuate the stool. The most recent and highest quality study 1 recommends a step-wise approach to managing fecal impaction, starting with manual disimpaction and enemas, and progressing to oral medications such as polyethylene glycol, lactulose, or magnesium citrate if necessary.
Initial Treatment
- Manual disimpaction by a healthcare provider to break up and remove the hardened stool
- Enemas such as mineral oil, sodium phosphate (Fleet), or milk and molasses enemas to soften and evacuate remaining stool
Oral Medications
- Polyethylene glycol (Miralax, 17g in 8oz water daily) 1
- Lactulose (15-30ml daily) 1
- Magnesium citrate (200-300ml as needed) 1
Prevention and Maintenance
- Stool softeners like docusate sodium (100mg twice daily) 1
- Increased fluid intake (at least 2 liters daily) 1
- Dietary fiber (25-30g daily) 1
- Regular physical activity 1
Underlying Causes
It is essential to address the underlying causes of fecal impaction to prevent recurrence and reduce the risk of complications. The study by 1 provides the most recent and highest quality evidence for the management of fecal impaction, and its recommendations should be prioritized in clinical practice.
From the FDA Drug Label
USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days Uses for prevention of dry, hard stools for relief of occasional constipation This product generally produces a bowel movement within 12 to 72 hours.
The treatment options for a fecal impaction may include:
- Polyethylene glycol (PO): can relieve occasional constipation and produce a bowel movement in 1 to 3 days 2
- Docusate sodium (PO): can prevent dry, hard stools and relieve occasional constipation, producing a bowel movement within 12 to 72 hours 3 Note: These options are for occasional constipation, and it is unclear if they are suitable for a fecal impaction. However, the provided drug labels do not directly address the treatment of fecal impaction.
From the Research
Treatment Options for Fecal Impaction
The treatment options for fecal impaction include:
- Manual disimpaction or fragmentation of the fecal mass 4, 5
- Use of distal and/or proximal softening or washout procedures such as enemas and suppositories 4, 6, 5
- Oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes 4, 7, 8
- Surgical intervention in severe cases, such as peritonitis resulting from bowel perforation 4, 5
Medication Therapy
Medication therapy, including stool softeners, oral mineral and olive oil, and edema, can be effective in treating mild and moderate fecal impaction 6
- Vegetable oil, Chinese traditional medicine, and enema can also be used in sequence to treat severe fecal impaction 6
- Polyethylene glycol solutions have been shown to be effective in treating constipation and fecal impaction, with low doses having fewer side-effects than lactulose 7
Prevention and Evaluation
Post-treatment evaluation should include a colonic evaluation by flexible sigmoidoscopy, a colonoscopy, or a barium enema after the fecal impaction resolves 4
- Implementing preventive measures, such as increasing daily water and fiber intake, limiting medications that decrease colonic motility, using secretagogues or prokinetic agents, and treating underlying anatomic defects, can help prevent recurrence 5