From the Guidelines
Treatment of ascending colon fecal impaction causing pain should start with disimpaction, usually through digital fragmentation and extraction of the stool, followed by the implementation of a maintenance bowel regimen to prevent recurrence. This approach is based on the most recent and highest quality study available, which emphasizes the importance of disimpaction in the management of fecal impaction 1. The study, published in the Annals of Oncology in 2018, provides a clear recommendation for the management of fecal impaction in the absence of suspected perforation or bleed.
Key considerations in the treatment of ascending colon fecal impaction include:
- Disimpaction as the initial step, which may involve digital fragmentation and extraction of the stool
- Implementation of a maintenance bowel regimen to prevent recurrence, which may include dietary changes, laxatives, and other measures to promote regular bowel movements
- Adequate hydration and pain management, which are crucial in preventing complications and improving patient outcomes
It is essential to note that the treatment approach may vary depending on the individual patient's needs and circumstances. However, the general principle of disimpaction followed by maintenance bowel regimen remains the cornerstone of treatment, as supported by the evidence 1. Throughout treatment, it is crucial to monitor the patient's symptoms and adjust the treatment plan as needed to ensure optimal outcomes and prevent complications.
From the FDA Drug Label
USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days The answer to treating ascending colon fecal impaction causing pain is not directly addressed by the information provided about polyethylene glycol (PO) 2.
- The label mentions relief of occasional constipation, but does not specifically address fecal impaction or pain.
- It does not provide guidance on the treatment of ascending colon fecal impaction. The FDA drug label does not answer the question.
From the Research
Treatment Options for Ascending Colon Fecal Impaction
- Manual extraction and proximal or distal washout are common treatment options for fecal impaction, as stated in 3.
- The use of polyethylene glycol (PEG) with or without electrolytes is also effective in treating fecal impaction, and is considered a first-line treatment for functional constipation, according to 4 and 5.
- PEG has been shown to be more efficacious than lactulose in treating chronic constipation and fecal impaction, with a lower incidence of adverse events, as reported in 5 and 6.
- In severe cases, surgical intervention may be necessary, as mentioned in 7.
Management of Fecal Impaction
- Early identification and treatment of fecal impaction are crucial to minimize complications and patient discomfort, as emphasized in 7 and 3.
- Post-treatment evaluation should include a colonic evaluation by flexible sigmoidoscopy, a colonoscopy, or a barium enema after the fecal impaction resolves, as recommended in 7.
- Following treatment, it is essential to conduct an evaluation of causes and create a preventive therapy plan to prevent recurrence, as suggested in 7 and 3.
Use of Polyethylene Glycol
- PEG with or without electrolytes is a safe and effective treatment for fecal impaction, and can be used as oral monotherapy, as demonstrated in 4 and 6.
- PEG has been shown to be well-tolerated by patients, with a low incidence of adverse events, as reported in 4 and 6.
- The use of PEG can help avoid the need for hospital admission and invasive interventions, as stated in 4 and 6.