From the Guidelines
Liquids administered through PEG tubes cannot directly form a fecaloma, but inadequate management of fluid intake and constipation can increase the risk of fecal impaction. A fecaloma is a large, hardened mass of stool that becomes impacted in the colon or rectum, typically resulting from severe constipation 1. Liquid nutrition and medications given through PEG tubes are absorbed in the small intestine, and while they can contribute to constipation if not properly managed, they do not directly solidify into fecalomas.
Key Considerations for PEG Tube Patients
- Ensure adequate hydration (1.5-2 liters of water daily through the tube) to prevent constipation 1
- Include fiber supplements if appropriate to promote regular bowel movements
- Consider a regular bowel regimen with osmotic laxatives like polyethylene glycol to manage constipation
- Implement a scheduled toileting routine to establish a regular bowel habit
- Regular assessment of bowel movements is essential, as early intervention for constipation can prevent the development of fecalomas 1
Managing Constipation in PEG Tube Patients
Patients with PEG tubes may develop constipation due to inadequate fluid intake, certain medications (especially opioids, anticholinergics, and some antidepressants), immobility, or neurological conditions affecting bowel motility 1. It is crucial to monitor bowel movements and adjust the bowel regimen as needed to prevent constipation and reduce the risk of fecal impaction. By prioritizing adequate hydration, fiber intake, and regular bowel movements, healthcare providers can minimize the risk of constipation and fecaloma formation in patients with PEG tubes 1.
From the Research
Fecaloma Formation in Patients with PEG Tubes
- There is no direct evidence to suggest that liquids can turn into a fecaloma in patients with PEG tubes 2, 3.
- Fecalomas are typically associated with chronic constipation and are usually found in the rectosigmoid area 4, 5.
- The formation of a fecaloma is often related to colonic sensorimotor disturbances and pelvic floor dysfunction, rather than the presence of a PEG tube 6.
PEG Tube-Related Complications
- PEG tubes can be associated with various complications, including tube-related complications and late complications associated with PEG tube use and wound care 2, 3.
- However, there is no specific evidence to suggest that PEG tubes can cause liquids to turn into a fecaloma 2, 3.
Management of Fecalomas
- Fecalomas can be treated with conservative methods such as laxatives, enemas, and rectal evacuation 4, 5.
- In some cases, surgical intervention may be necessary to remove the fecaloma 4.
- The use of polyethylene glycol (PEG) and sodium picosulphate (SPS) has been shown to be effective in treating fecal impaction in children 5.