From the Guidelines
The most effective treatment for fecal impaction is a combination approach, starting with rectal options such as suppositories and enemas, followed by oral medications to prevent recurrence, as recommended by the most recent and highest quality study 1.
Treatment Options
The treatment of fecal impaction involves the use of oral and rectal laxatives. Oral options include:
- Polyethylene glycol (MiraLAX, 17g in 8oz water daily)
- Magnesium citrate (10oz)
- Mineral oil (15-45ml) Rectal treatments, which often work faster, include:
- Glycerin suppositories
- Bisacodyl suppositories (10mg)
- Mineral oil enemas (100-250ml)
- Saline enemas (Fleet enema)
Rationale for Treatment
The use of suppositories and enemas is a preferred first-line therapy when a digital rectal examination (DRE) identifies a full rectum or fecal impaction, as stated in the ESMO clinical practice guidelines 1. Enemas and suppositories increase water content and stimulate peristalsis to aid in expulsion, and both work more quickly than oral laxatives.
Potential Complications and Contraindications
Enemas are contraindicated for patients with neutropenia or thrombocytopenia, paralytic ileus or intestinal obstruction, recent colorectal or gynecological surgery, recent anal or rectal trauma, severe colitis, inflammation or infection of the abdomen, toxic megacolon, undiagnosed abdominal pain, or recent radiotherapy to the pelvic area, as noted in the guidelines 1.
Additional Considerations
Manual disimpaction might be necessary in resistant cases, and maintaining a high-fiber diet (25-30g daily), adequate hydration (8 glasses of water daily), and regular physical activity helps prevent recurrence, as suggested by the guidelines 1. Patients with heart or kidney disease should consult a healthcare provider before using magnesium or sodium-containing products.
From the FDA Drug Label
STOP USE AND ASK A DOCTOR IF • you have rectal bleeding or your nausea, bloating, cramping or abdominal pain gets worse. These may be signs of a serious condition. Other laxatives should not be used, especially during the initial phase of therapy for portal-systemic encephalopathy because the loose stools resulting from their use may falsely suggest that adequate lactulose dosage has been achieved.
The treatment options for fecal impaction are not explicitly stated in the provided drug labels. However, polyethylene glycol (PO) and lactulose (PO) are laxatives that may be used to treat constipation, which can be a contributing factor to fecal impaction.
- Polyethylene glycol (PO) 2 may be used to treat constipation, but it is essential to stop use and ask a doctor if symptoms worsen.
- Lactulose (PO) 3 may be used to treat constipation, but other laxatives should not be used, especially during the initial phase of therapy. It is crucial to consult a doctor for proper diagnosis and treatment of fecal impaction.
From the Research
Treatment Options for Fecal Impaction
- Manual disimpaction or fragmentation of the rectum 4
- Use of distal and/or proximal softening or washout procedures such as enemas and suppositories 4, 5, 6
- Oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes 4, 7
- Surgical intervention in severe cases 4, 5
- Stool softeners, oral mineral and olive oil, and edema for mild and moderate fecal impaction 5
- Vegetable oil, Chinese traditional medicine, and enema for severe fecal impaction 5
- Mineral oil or warm water enemas for fecal impaction in older adults 8
- Lifestyle modifications, such as scheduled toileting after meals, increased fluid intake, and increased dietary fiber intake 8
- Additional fiber intake in the form of polycarbophil, methylcellulose, or psyllium 8
- Osmotic laxatives, such as polyethylene glycol, followed by a stool softener, such as docusate sodium, and then stimulant laxatives 8