From the Research
The initial management for stercoral proctitis in geriatric patients should focus on fecal disimpaction, bowel regimen optimization, and supportive care, as recommended by the most recent and highest quality study available 1.
Key Components of Management
- Begin with a digital rectal examination to assess for impacted stool, followed by gentle manual disimpaction if needed, as suggested by 2 and 1.
- Administer enemas such as mineral oil or sodium phosphate to soften and evacuate hardened stool, as recommended by 3 and 1.
- Oral laxatives including polyethylene glycol (17-34g daily), docusate sodium (100mg twice daily), or lactulose (15-30ml daily) should be initiated to establish regular bowel movements, as suggested by 3.
Supportive Care and Prevention of Complications
- Ensure adequate hydration with at least 1.5-2 liters of fluid daily and increase dietary fiber gradually to 25-30g per day, as recommended by 3 and 1.
- Pain management with acetaminophen (500-1000mg every 6 hours, not exceeding 3000mg daily in elderly) is appropriate, avoiding opioids which can worsen constipation, as suggested by 4 and 3.
- Monitor for complications such as rectal bleeding, perforation, or sepsis, as highlighted by 2 and 1.