How to manage fecal loading during an Inflammatory Bowel Disease (IBD) flare?

From the Guidelines

Managing fecal loading during an inflammatory bowel disease (IBD) flare requires a comprehensive approach that prioritizes hydration, dietary adjustments, and medication management to minimize morbidity, mortality, and improve quality of life. The most recent and highest quality study, 1, emphasizes the importance of diet and nutrition in IBD management, highlighting the benefits of a Mediterranean diet rich in fruits, vegetables, and monounsaturated fats.

Key Recommendations

• Increase fluid intake to at least 2-3 liters daily to help soften stool and prevent dehydration, as recommended by 1.
• Modify diet to include soluble fiber (oatmeal, bananas) while temporarily reducing insoluble fiber to facilitate easier passage of stool.
• Consider osmotic laxatives like polyethylene glycol (Miralax, 17g in 8oz water daily) or lactulose (15-30ml daily) to soften stool and facilitate passage.
• For more severe impaction, consider stimulant laxatives such as bisacodyl (5-10mg orally) or senna (8.6-17.2mg at bedtime), and manual disimpaction may be necessary in severe cases but should be performed by healthcare professionals.
• Maintain any prescribed IBD medications as directed, as untreated inflammation can worsen constipation, and consider the role of enteral liquid nutrition in inducing remission and correcting malnutrition, especially in patients with Crohn’s disease, as suggested by 1.

Additional Considerations

• Physical activity, even gentle walking, can stimulate bowel motility and improve overall health outcomes.
• Positioning yourself properly during bowel movements using a footstool to create a squatting position can facilitate easier passage of stool.
• Contact your healthcare provider if you experience severe pain, inability to pass gas, vomiting, or fever, as these may indicate complications requiring immediate attention.
• The importance of interdisciplinary teams, including registered dietitians, in managing patients with IBD, especially those with short bowel syndrome or intestinal failure, is highlighted by 1, emphasizing the need for personalized nutritional advice and support.

Prioritizing Morbidity, Mortality, and Quality of Life

The management of fecal loading during an IBD flare should always prioritize minimizing morbidity, mortality, and improving quality of life. This involves careful consideration of the patient's overall health status, nutritional needs, and the potential risks and benefits of different management strategies. By following a comprehensive approach that incorporates the latest evidence and guidelines, healthcare providers can help patients with IBD manage fecal loading effectively and improve their overall outcomes.

From the Research

Managing Fecal Loading during an IBD Flare

• There are no specific studies provided that directly address the management of fecal loading during an Inflammatory Bowel Disease (IBD) flare.
• However, the management of IBD flares is discussed in several studies, including the use of biologics and small molecule drugs 2, infliximab precision dosing 3, and the management of IBD flares in the emergency department 4.
• The study on extraintestinal manifestations of IBD 5 highlights the importance of recognizing and managing these manifestations, which can occur in up to 24% of patients with IBD.
• The use of biosimilars, such as adalimumab biosimilars, is also discussed as a potential treatment option for IBD patients 6.
• In terms of managing fecal loading, it is likely that the treatment of the underlying IBD flare will also help to manage fecal loading, but this is not explicitly stated in the provided studies.
• The management of IBD flares in the emergency department 4 may involve laboratory testing, imaging, and identification of surgical emergencies, which could potentially include the management of fecal loading.