Management and prevention of fecal impaction

Abstract

Fecal impactions occur in both sexes at any age but are particularly concentrated in children, in the institutionalized or impaired elderly, and in patients with certain psychiatric disorders or medical conditions that predispose to obstipation. The clinical consequences may be disabling and occasionally life threatening. Clinical manifestations include fecal incontinence, abdominal distention and pain, anorexia, weight loss, intestinal obstruction, and stercoral ulceration with bleeding or colonic perforation. Diagnosis begins with recognition of possible fecal impaction and confirmation by digital examination or abdominal radiography. Management consists of disimpaction, colon evacuation, and a maintenance bowel program to prevent recurrent impactions.

Opioid-Induced Constipation: Pathophysiology, Clinical Consequences, and Management

“…Treating faecal impaction involves initial disimpaction, usually manual evacuation of faeces followed by an enema with either warm water and mineral oil or milk and molasses. Maintenance therapy should comprise regular polyethylene glycol (PEG), which is superior to lactulose at preventing recurrence [15]. …”

Pathophysiological analysis and strategy for stercoral perforation of the colon

“…Severe chronic constipation is considered to be the main causative factor in the development of stercoral perforation of the colon [1,5,7,[12][13][14][15]. The fecalomas exert a constant pressure on the bowel wall and lead to pressure necrosis of the mucosa.…”

Not your usual constipation: stercoral perforation

“…Stercoral perforation is a rare but lethal complication of constipation and faecal impaction. Early diagnosis of faecal impaction and aggressive treatment by manual disimpaction and enemas may prevent this complication 5 11. Maintenance laxative therapy is recommended to prevent further episodes of impaction 5 11.…”

“…Early diagnosis of faecal impaction and aggressive treatment by manual disimpaction and enemas may prevent this complication 5 11. Maintenance laxative therapy is recommended to prevent further episodes of impaction 5 11. It is recommended to maintain a high index of suspicion for stercoral perforation in patients with a history of chronic constipation who present with acute abdominal pain.…”