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Fecal impaction is a common result of neurogenic bowel dysfunction and causes immense discomfort and pain. Its treatment includes laxatives, enemas, and pulsed irrigation evacuation (PIE) as well as digital removal. It is not a condition that resolves without direct treatment.
Bowel management is the process which a person with a bowel disability uses to manage fecal incontinence or constipation. [1] People who have a medical condition which impairs control of their defecation use bowel management techniques to choose a predictable time and place to evacuate. [1]
In later stages of constipation, the abdomen may become distended, hard and diffusely tender. Severe cases ("fecal impaction" or malignant constipation) may exhibit symptoms of bowel obstruction (nausea, vomiting, tender abdomen) and encopresis, where soft stool from the small intestine bypasses the mass of impacted fecal matter in the colon.
Additionally, fecalomas may be seen as masses in the colon. In the case of ulceration, the part of the colon adjacent to the fecaloma will be thickened. This thickening of the bowel will help differentiate from stercoral colitis and stercoral ulcer from fecal impaction as the colon is typically not thickened in cases of fecal impaction. [2]
As bowel stimulants, enemas are employed for the same purposes as orally administered laxatives: to relieve constipation; to treat fecal impaction; to empty the colon prior to a medical procedure such as a colonoscopy. When oral laxatives are not indicated or are not sufficiently effective, enemas may be a sensible and necessary measure. [9]
It can form secondary to fecal impaction. A fecaloma is a more severe form of fecal impaction, and a hardened fecaloma may be considered a giant fecalith. The term is from the Greek líthos =stone.
Pharmacological treatment for children with functional constipation consists of maintenance therapy and faecal disimpaction. High-dose oral polyethylene glycol (PEG) or enemas containing active substances can induce fecal disimpaction, while maintenance therapy is recommended after successful disimpaction to avoid reoccurring stool buildup.
Limited data also support its use for the treatment of fecal impaction. [18] In those with chronic constipation it works better than lactulose. [19] A 2007 comparison showed that people with constipation had a better response to macrogol than to tegaserod. [20] Popular types include: macrogol 3350, [21] macrogol 4000, and macrogol 6000. [22]