From the Guidelines
Stercoral constipation management requires prompt intervention to prevent complications like bowel perforation, and the most effective approach includes a combination of digital rectal examination, manual disimpaction if needed, and the use of enemas and oral laxatives, as recommended by the most recent guidelines 1.
Initial Management
Initial management includes:
- Digital rectal examination to assess for impaction
- Manual disimpaction if needed
- Administering enemas such as sodium phosphate (Fleet) or mineral oil to soften the hardened stool
Oral Laxatives
Oral laxatives are essential, with polyethylene glycol (17-34g daily) being the preferred option due to its efficacy and safety profile, as supported by recent studies 1.
Additional Interventions
For refractory cases, stimulant laxatives like bisacodyl (5-10mg) or senna (8.6-17.2mg) can be added, and adequate hydration is crucial, aiming for 2-3 liters of fluid daily.
Severe Cases
For severe cases, consider hospitalization for more aggressive interventions including water-soluble contrast enemas or, rarely, surgical intervention if perforation occurs, as recommended by guidelines 1.
Maintenance Regimen
After resolution, implement a maintenance regimen with fiber supplementation (20-30g daily), continued hydration, and regular physical activity to prevent recurrence, as suggested by recent guidelines 1.
Prevention
Stercoral constipation develops when feces become extremely hard and impacted, typically due to prolonged colonic transit time allowing excessive water absorption from stool, and is more common in elderly, immobile patients and those on constipating medications like opioids or anticholinergics, making prevention through regular bowel regimens essential in high-risk populations, as highlighted by studies 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.