From the Research
Antibiotic treatment is not necessary for stercoral colitis unless there is evidence of bacterial infection, perforation, or sepsis. The primary treatment for stercoral colitis focuses on relieving the fecal impaction through manual disimpaction, enemas, or laxatives such as polyethylene glycol (MiraLAX), lactulose, or magnesium citrate 1. Intravenous fluids are often necessary to correct dehydration, and pain management may be required using medications like acetaminophen or, cautiously, opioids.
Key Considerations
- The condition results from prolonged constipation causing pressure necrosis of the colonic wall from hardened stool, not primarily from bacterial infection 2.
- After resolving the acute episode, prevention is crucial through maintenance laxatives, increased fluid intake (at least 2 liters daily), dietary fiber (25-30g daily), and regular physical activity.
- Patients with recurrent episodes may need a scheduled bowel regimen with stool softeners like docusate sodium and osmotic laxatives.
- CT scans can help diagnose stercoral colitis, but there are no established diagnostic criteria for the condition 2.
- Treatment depends on the severity of illness, ranging from manual disimpaction and other conservative measures for most cases, to surgical intervention for complicated cases, such as stercoral perforation 3, 4.
Management Approach
- Manual disimpaction and laxatives are the primary treatment for stercoral colitis, with antibiotics reserved for cases with evidence of bacterial infection, perforation, or sepsis 1, 5.
- A multidisciplinary approach to management is essential, involving emergency clinicians, surgeons, and other specialists as needed 1, 2.
- Timely recognition and appropriate treatment are critical to reducing morbidity and mortality associated with stercoral colitis 2.