From the Guidelines
A fecal disimpaction procedure is a medical intervention used to remove hardened stool that has become impacted in the rectum when a person is severely constipated, typically involving manual removal of the impacted stool by a healthcare provider who inserts a gloved, lubricated finger into the rectum to break up and remove the hardened feces, as recommended by the most recent guidelines 1.
Key Points
- The procedure is usually performed after less invasive methods, such as oral laxatives, suppositories, or enemas, have been tried first.
- The patient is typically positioned on their left side with knees bent, and the healthcare provider uses lubricating jelly to minimize discomfort.
- The procedure can be uncomfortable and may require pain medication or sedation in some cases.
- After disimpaction, a bowel maintenance regimen is typically prescribed to prevent recurrence, including increased fluid intake, dietary fiber, regular exercise, and sometimes scheduled laxatives, as outlined in the guidelines 1.
Considerations
- Fecal impaction occurs when stool becomes so hard and dry that normal bowel movements are impossible, often resulting from prolonged constipation, medication side effects, neurological conditions, or immobility.
- The guidelines recommend disimpaction, usually through digital fragmentation and extraction of the stool, followed by the implementation of a maintenance bowel regimen to prevent recurrence, in the absence of suspected perforation or bleed 1.
- Other studies, such as those published in 2016 1 and 2009 1, provide additional guidance on the management of constipation and fecal impaction, but the most recent guidelines 1 should be prioritized.
From the Research
Fecal Disimpaction Procedure
- Fecal disimpaction is a procedure used to treat fecal impaction, a condition where a mass of feces becomes stuck in the colon or rectum 2.
- The procedure typically involves manual fragmentation and extraction of the fecal mass, distal colonic cleansing using enemas and rectal lavage with the aid of a sigmoidoscope, and/or using water-soluble contrast media such as Gastrografin to both identify the extent of the impaction and aid in cleansing and removal 2.
- In some cases, polyethylene glycol (PEG) may be used to help soften and remove the impacted feces, either alone or in combination with other treatments such as enemas or laxatives 3.
- The goal of the procedure is to remove the impacted feces and restore normal bowel function, while also preventing complications such as bowel obstruction, perforation, or peritonitis 2.
Treatment Options
- Manual disimpaction: a procedure where a healthcare provider uses their hands or a tool to break up and remove the impacted feces 2.
- Enemas and rectal lavage: a procedure where a liquid solution is inserted into the rectum to help soften and remove the impacted feces 2.
- Polyethylene glycol (PEG): an osmotic laxative that can be used to help soften and remove the impacted feces 3.
- Water-soluble contrast media: a substance used to help identify the extent of the impaction and aid in cleansing and removal 2.
Important Considerations
- Fecal disimpaction is typically performed in a healthcare setting, such as a hospital or clinic, and may require anesthesia or sedation to help the patient relax and reduce discomfort 2.
- The procedure can be uncomfortable and may cause some bleeding or discomfort, but it is usually effective in removing the impacted feces and restoring normal bowel function 2.
- Preventive measures, such as increasing daily water and fiber intake, limiting medications that decrease colonic motility, and treating underlying anatomic defects, can help reduce the risk of fecal impaction and the need for disimpaction procedures 2.