From the Guidelines
Stercoral constipation management requires prompt intervention to prevent complications like perforation and sepsis, and the most effective approach includes bowel disimpaction using manual removal, enemas, or high-volume polyethylene glycol (PEG) solutions, followed by maintenance therapy with stool softeners, osmotic laxatives, and stimulant laxatives as needed, as recommended by the most recent guidelines 1.
Initial Management
Initial management of stercoral constipation involves bowel disimpaction, which can be achieved through:
- Manual removal
- Enemas (such as sodium phosphate or mineral oil)
- High-volume polyethylene glycol (PEG) solutions like GoLYTELY or MoviPrep (2-4 liters)
Maintenance Therapy
Once the impaction is cleared, maintenance therapy should include:
- Stool softeners like docusate sodium (100mg twice daily)
- Osmotic laxatives such as PEG 3350 (17g daily) or lactulose (15-30ml daily)
- Stimulant laxatives like bisacodyl (5-10mg daily) or senna (8.6-17.2mg daily) as needed
Additional Recommendations
- Adequate hydration (at least 2 liters of fluid daily) and dietary modifications including increased fiber intake (25-30g daily) are essential
- Physical activity should be encouraged as mobility helps stimulate bowel motility
- For patients with recurrent stercoral constipation, a scheduled bowel regimen is crucial, and underlying causes such as medication side effects, neurological disorders, or metabolic abnormalities should be addressed
- Regular monitoring and adjustment of the regimen based on stool consistency using the Bristol Stool Chart helps prevent recurrence of this potentially dangerous condition, as supported by recent guidelines 1
Key Considerations
- The use of suppositories and enemas is a preferred first-line therapy when a full rectum or faecal impaction is identified, as recommended by recent guidelines 1
- Methylnaltrexone, a peripherally acting μ-opioid receptor antagonist, may be considered for patients experiencing constipation that has not responded to standard laxative therapy, as recommended by recent guidelines 1
From the Research
Stercoral Constipation Management
- Stercoral colitis is a rare but potentially life-threatening condition caused by the accumulation of impacted fecal material, often occurring in elderly or bedbound patients with chronic constipation 2.
- The clinical presentation of stercoral colitis can be nonspecific and varied, with patients presenting with abdominal pain and distension, and diagnosis is often made using CT scans to reveal key findings such as fecaloma, colonic dilatation, and fat stranding 2.
- Treatment for stercoral colitis depends on the severity of the illness, ranging from manual disimpaction and conservative measures for most cases, to surgical intervention for complicated cases such as stercoral perforation 2.
- In the emergency department, constipation is a clinical diagnosis, and ideal management includes excluding dangerous mimics or complications and discharging the patient with a bowel regimen tailored to the likely cause of their constipation, with appropriate referral to primary or specialty care 3.
- First-line management of constipation includes lifestyle changes such as increased physical activity, high-fiber diets, adequate fluid intake, and bowel management techniques, with biofeedback and pharmacologic therapies available for refractory cases 4.
Diagnostic Approaches
- There are no established diagnostic criteria for stercoral colitis, and diagnosis is often made using CT scans to reveal key findings such as fecaloma, colonic dilatation, and fat stranding 2.
- An evaluation of constipation begins with a focused history of a person's bowel habit, medications, diet, physical activity, and anorectal examination, with diagnostic testing not routinely recommended in the initial evaluation unless alarm signs are present 4.
- Anorectal manometry may be used to assess outlet function in patients with refractory constipation, with additional testing required in some cases 4.
Treatment Options
- Manual disimpaction and conservative measures are often used to treat stercoral colitis, with surgical intervention required for complicated cases such as stercoral perforation 2.
- Lifestyle changes such as increased physical activity, high-fiber diets, adequate fluid intake, and bowel management techniques are recommended as first-line management for constipation, with biofeedback and pharmacologic therapies available for refractory cases 4.
- A range of traditional and new pharmacologic therapies are available to remedy constipation, from stool softeners to agents that increase intestinal transit 4.