From the Research
Management of stercoral colitis requires prompt intervention to prevent serious complications like perforation and sepsis, with initial treatment focusing on fecal disimpaction through manual disimpaction, enemas, or colonoscopic removal of the impacted stool, as recommended by the most recent study 1. The goal of treatment is to relieve the impaction, manage symptoms, and prevent complications.
- Initial treatment should include:
- Fecal disimpaction through manual disimpaction, enemas, or colonoscopic removal of the impacted stool
- Aggressive bowel cleansing using polyethylene glycol solutions (GoLYTELY or MiraLAX) at doses of 1-2 liters orally or via nasogastric tube until the stool is cleared
- Intravenous fluids to correct dehydration and electrolyte imbalances
- Pain management with appropriate analgesics
- If there are signs of infection, broad-spectrum antibiotics covering gram-negative and anaerobic bacteria (such as piperacillin-tazobactam 3.375g IV every 6 hours or ceftriaxone 1-2g IV daily plus metronidazole 500mg IV every 8 hours) should be administered, as suggested by 2.
- Surgical consultation is necessary if perforation is suspected, indicated by severe abdominal pain, peritoneal signs, or free air on imaging, as highlighted in 3. After the acute episode resolves, prevention of recurrence is crucial through:
- A high-fiber diet (25-30g daily)
- Adequate hydration (2-3 liters daily)
- Regular physical activity
- A bowel regimen that may include stool softeners (docusate sodium 100mg twice daily), osmotic laxatives (MiraLAX 17g daily), or stimulant laxatives (bisacodyl 5-10mg daily) as needed, as recommended by 4. This comprehensive approach addresses the immediate impaction while establishing preventive measures to avoid future episodes of this potentially life-threatening condition.