Hospital Procedure: Removing Impacted Stool Safely

Fecal impaction is a severe form of constipation, where a hard, dry mass of stool becomes stuck in the colon or rectum. This can lead to serious health issues and even death if left untreated. Treatment for fecal impaction typically involves softening and removing the impacted stool, which can be done through various methods. So, how does a hospital remove impacted stool?

Enema: Inserting fluid into the rectum to soften and remove impacted stool

An enema is a procedure used to treat impacted stool, also known as a fecal impaction. This occurs when a hard, dry mass of stool becomes stuck in the colon or rectum, causing pain and bloating. Enemas are an effective way to soften and remove impacted stool, and they are often used when lifestyle changes and oral laxatives have not helped to relieve constipation.

During an enema, a fluid is inserted into the rectum, creating pressure inside the colon. This pressure triggers a reflex that stimulates bowel movements. The fluid used in an enema may be a saline solution or a solution of water with other ingredients, such as phosphate, sodium butyrate, organic acids, or A-300 silicon dioxide. The amount of fluid used can vary depending on the type of enema and the location of the impaction. For example, a large volume enema uses 500-1000 ml of fluid to cleanse a large part of the colon, while a small volume enema uses less than 500 ml to target the lower part of the colon. An oil-retention enema, used for hardened stool, typically contains 90-120 ml of solution.

The procedure for administering an enema involves inserting a tube into the anus and slowly injecting small amounts of fluid. The person receiving the enema should try to hold the fluid in for a short period, typically around 1-5 minutes, to allow the fluid to soften the stool. They may also be instructed to gently massage their lower abdomen to encourage the fluid and stool to leave the body. It is important to follow the instructions provided by a healthcare professional when administering an enema to avoid potential side effects and complications.

Enemas can be self-administered or performed by a healthcare provider. They are generally considered a safe and effective treatment for impacted stool, but it is important to be gentle during the procedure to avoid tissue damage. In some cases, enemas may not be suitable, such as for individuals with a compromised immune system or those with colon surgery in their medical history. Additionally, overuse of enemas can lead to long-term constipation issues.

Laxatives: Oral medication to stimulate bowel movements and clear the colon

Laxatives are oral medications that treat constipation by softening hard stools or stimulating the bowels to get moving so you can pass stool. They are typically used to treat occasional or short-term constipation. Laxatives are generally safe and available without a prescription, but they are not suitable for everyone, and some laxatives may interfere with prescription medications. Therefore, it is essential to consult a healthcare provider before taking laxatives, especially if you are pregnant or giving laxatives to a child.

There are several types of laxatives, including bulk-forming laxatives, osmotics, stool softeners, lubricants, and stimulants. Bulk-forming laxatives "bulk" up your stool by adding soluble fiber to your poop, making it bigger and softer. The increase in size stimulates your colon to contract and push the stool out. Examples of bulk-forming laxatives include psyllium (Metamucil), polycarbophil (FiberCon), and methylcellulose (Citrucel).

Osmotic laxatives, such as polyethylene glycol (PEG) solutions, draw water from other body parts and send it to your colon. The water collects in the colon, softening the stool and making it easier to pass. Polyethylene glycol comes in powder form and dissolves in water or another drink. It may need to be taken for 2-4 days to produce a bowel movement.

Stimulant laxatives, such as bisacodyl (Dulcolax) and senna (Fletcher's Laxative), activate the nerves that control the muscles in your colon, forcing it into motion and moving your stool along. These laxatives are typically recommended if other over-the-counter types have not been effective.

Stool softeners and lubricants, such as mineral oil, add moisture to the stool, making it softer and easier to pass. They are particularly useful if you have an internal tear or fissure or pain from hemorrhoids during bowel movements. Stool softeners can be taken in capsule, tablet, liquid, or syrup form, usually at bedtime. Lubricants should not be taken simultaneously with stool softeners, and mineral oil should not be used for more than a few days as it can interfere with vitamin absorption.

It is important to take laxatives as directed to prevent side effects such as bloating, gas, or stomach cramps. Additionally, it is recommended to seek medical help if you have used a laxative for more than a week without resolving constipation.

Manual removal: A medical professional uses a gloved finger to break up and remove stool

Manual removal of impacted stool, also known as digital disimpaction, is a procedure performed by a medical professional to break up and remove the impacted stool from a patient's rectum using a gloved finger. This procedure is typically carried out when other methods, such as laxatives, enemas, or stool softeners, have been unsuccessful in treating the patient's severe constipation or fecal impaction.

During the manual removal procedure, the medical professional wears sterile gloves to ensure personal hygiene and prevent the risk of infection. The patient lies on their left side, and the medical professional applies lubrication to their gloved finger. This lubrication aids in the insertion of the finger into the patient's rectum and helps to break up the hardened stool.

The medical professional then inserts their finger into the patient's rectum and gently locates the impacted stool. They carefully break up the hardened stool into smaller pieces, slowly removing it from the rectum. This process is repeated until all the fecal matter has been cleared. The area is then cleaned with toilet paper, soap, and water, and proper handwashing techniques are followed afterward.

Manual removal of impacted stool is a short-term solution and should only be performed by trained medical professionals or caregivers. It is important to note that regular use of this procedure can have adverse effects, including hemorrhoids, anal fissures, rectal perforation, infection, and worsening defecation problems. Therefore, it is recommended as a last resort when other treatment options have been exhausted.

Water irrigation: Using a small hose to push water into the colon, removing stool

Water irrigation is a procedure to remove impacted stool from the colon. It involves inserting a small hose into the rectum and flushing the area with water, encouraging the stool to soften and break down. The hose is connected to a machine that emits water through the tube. This procedure can be carried out by a doctor or healthcare provider and may be done in a hospital or healthcare provider's office. It is typically considered minimally invasive.

During water irrigation, the doctor will insert a small hose through the rectum and into the colon. The water is then pushed through the hose and into the colon, softening and breaking down the impacted stool. The water may be delivered in rapid pulses, using an electrical pump, to help break up the stool. The procedure may also be known as transanal irrigation (TAI), as water is introduced to the colon via the anus.

After the irrigation, the doctor may massage the abdomen to help move the waste out of the rectum. This can be done by hand or with the aid of another tube. The patient may also be instructed to gently massage their lower abdomen to encourage the fluid and stool to leave the body. The patient may need to undergo several rounds of irrigation until the liquid leaving their body is clear.

Water irrigation is a safe procedure with a low risk of bowel perforation. It is one of several treatment options for impacted stool and may be recommended if other treatments, such as enemas or suppositories, have not been successful. It is important to seek medical help promptly for constipation to avoid fecal impaction, which can lead to damage in the rectum and other serious health complications.

Surgery: A last resort for severe cases, to remove stool and treat tears

Surgery is a last resort for severe cases of impacted stool. It is performed when other treatments, such as enemas, manual removal, stool softeners, and laxatives, have failed to remove the blockage.

Impacted stool, or fecal impaction, occurs when a hard, dry mass of stool becomes stuck in the colon or rectum. This is often due to severe or untreated constipation, but can also be caused by other factors such as dehydration, lack of fiber, certain medications, or underlying illnesses.

In severe cases of fecal impaction, surgery may be necessary to remove the impacted stool and treat any tears in the bowel. This is especially important when there is bleeding due to a tear in the bowel, known as bowel perforation. During the surgery, the blockage is removed, and the patient should experience relief from discomfort or pain in the lower abdominal region.

It is important to note that surgery is not the first line of treatment for impacted stool. Healthcare providers will typically recommend conservative measures first, such as enemas, manual removal, and laxatives, before considering surgery. However, if these methods do not successfully remove the blockage, surgery may be the best option to prevent dangerous and potentially life-threatening complications.

Additionally, surgery may be required in cases where fecal impaction has led to a tear in the bowel, even if the blockage itself has been successfully cleared. This is because bleeding and potential infection from a bowel perforation can be life-threatening and require immediate medical intervention.

Frequently asked questions