From the Guidelines
Fecal impaction should be treated with manual disimpaction followed by a bowel regimen to prevent recurrence, as recommended by the most recent guidelines [Annals of Oncology, 2018] 1.
Treatment Approach
The treatment approach for fecal impaction involves:
- Manual disimpaction, which is usually performed through digital fragmentation and extraction of the stool
- Implementation of a maintenance bowel regimen to prevent recurrence
Maintenance Bowel Regimen
A maintenance bowel regimen may include:
- Oral laxatives such as polyethylene glycol (MiraLAX, 17g in 8oz water daily) or lactulose (15-30ml twice daily) to soften remaining stool
- Suppositories like bisacodyl (10mg) or enemas (mineral oil or phosphate) to help evacuate the lower bowel
- Increased fluid intake to 2-3 liters daily
- Gradual addition of fiber to the diet
- Maintenance of physical activity to prevent recurrence
- A maintenance regimen with stool softeners like docusate sodium (100mg twice daily) may be needed for those at risk, although the addition of stool softeners may not be necessary in all cases 1.
Important Considerations
It is essential to note that the treatment of fecal impaction should prioritize the prevention of recurrence, and a comprehensive approach is necessary to resolve the current impaction and prevent future episodes. The treatment should be individualized based on the patient's specific needs and medical history.
From the Research
Treatment Options for Fecal Impaction
- Manual disimpaction or fragmentation, the use of distal and/or proximal softening or washout procedures such as enemas and suppositories, and oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes are common treatment options for fecal impaction of the rectum 2
- In severe cases, surgical intervention is necessary 2
- Mineral oil or warm water enemas can be used to treat fecal impaction 3
- A combined regimen of polyethylene glycol and sodium picosulphate can be effective in treating fecal impaction in children 4, 5
- A high-dose oral protocol combining polyethylene glycol with electrolytes and sodium picosulphate can successfully disimpact children with acute/chronic constipation in an outpatient setting 5
- Fecal disimpaction and aggressive bowel regimen can prevent the pathological effects of severe fecal retention 6
Post-Treatment Evaluation
- Post-treatment evaluation should include a colonic evaluation by flexible sigmoidoscopy, a colonoscopy, or a barium enema after the fecal impaction resolves 2
- An evaluation of causes and creation of a preventive therapy plan should be conducted following treatment 2