HWN Suggests

Trick of Trade: Topical lidocaine jelly to make constipation relief less painful

Severe constipation, requiring fecal disimpaction and rectal enemas, can be excruciatingly painful for patients. Administering sedatives and opioids to help alleviate this pain poses a challenge, because many of the patients are elderly and tend to be more sensitive to these medications. Furthermore, there may be increased vagal tone when straining, leading to hypotension and bradycardia and which can result in defecation-related syncope. 1 Also, opioids can exacerbate constipation.

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Articles of Interest

Did You Know Fecal Impaction is Common in Children Too?

Childhood fecal impaction can be caused by any of the following issues: not chewing food properly leading to indigestion, improper foods that cause stools to harden and make them difficult to pass children avoiding going to the bathroom and having a tendency to hold in bowel movements.

Fecal Impaction Not Always a Benign Condition

This diagnosis is often delayed because elderly institutionalized patients may not be cognizant of their symptoms and may not be able to express themselves adequately. The first indication of the impaction may be diarrhea and rectal incontinence that the unsuspecting physician may treat with an antidiarrheal agent, thereby compounding the problem.

Fecal Impaction: A Cause for Concern?

Fecal impaction (FI) is a common cause of lower gastrointestinal tract obstruction lagging behind stricture for diverticulitis and colon cancer. It is the result of chronic or severe constipation and most commonly found in the elderly population.

Fecal impaction: a systematic review of its medical complications

FI causes complications that might be fatal. The elderly, underlying neuropsychiatric disease and hospitalised or institutionalised patients integrate the high-risk group in which FI must be suspected.

Resources

Constipation – It’s a dirty job, …

Disimpaction (for those with h/o stool withholding and fecal mass present), Oral, rectal, or combination are effective, Rectal enemas may not be the best 1st option as they may exacerbate the psychologic problem, Glycerin suppositories (< 6yrs – one infant suppository), Milk of Magnesia (<2yr – 0.5 mL/kg/Day; 2-5yrs – 5-15mL/Day; 6-12yrs – 15-30ml/Day), Mineral Oil (>4yrs – 15-30 mL/ year of age), MIRALAX (<18mos – 0.78g/kg/Day; 2-11yr – 8.5g/4 oz water; >12yr – 17 g/8 oz water).

StatPearls

The enema is best delivered with a Foley catheter past the hardened stool. The best method is to use ample water and combine it with docusate or sorbitol.

WikEM

Distal impactions - manual disimpaction and/or rectal suppositories or enemas.