{
  "schemaVersion": 2,
  "eyebrow": "Gastroenterology",
  "title": "Fecal Impaction",
  "summary": "Diagnose fecal impaction with targeted abdominal and digital rectal examination, exclude obstruction or ischemic complications when suggested clinically, achieve complete clearance, then reassess bowel function and contributors to prevent recurrent loading.",
  "seoDescription": "Physician guide to diagnosing and treating fecal impaction, selecting disimpaction methods, recognizing complications, and preventing recurrence.",
  "clinicalQuestion": "How should clinicians confirm, clear, and prevent recurrent fecal impaction while identifying patients needing urgent escalation?",
  "specialty": "Gastroenterology",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "fecal impaction",
    "fecal loading",
    "digital rectal examination",
    "manual disimpaction",
    "polyethylene glycol",
    "stercoral perforation",
    "constipation"
  ],
  "keyTakeaways": [
    "Perform a digital rectal examination early: it can identify rectal stool loading, stricture, bleeding, pain, weak sphincters, and dyssynergic evacuation that change immediate management. [4][18][22]",
    "A firm rectal fecal mass should be treated with manual disimpaction; use oral or rectal laxative-based clearance strategies when impaction is not limited to a removable rectal mass. [15][22][23]",
    "Escalate urgently for suspected stercoral ischemia or perforation; untreated impaction can progress to ulceration, necrosis, and perforation, with reported mortality as high as 60% after perforation. [17]",
    "After clearance, repeat assessment for residual impaction and address persistent constipation or evacuation dysfunction; fecal incontinence may coexist with constipation and evacuation disorders. [4][22]"
  ],
  "sections": [
    {
      "id": "triage-for-complications",
      "eyebrow": "Immediate decision",
      "heading": "Identify patients who need urgent imaging and surgical evaluation",
      "intro": "Do not treat presumed uncomplicated impaction without reassessing for pressure injury or perforation.",
      "paragraphs": [
        "Treat fecal impaction as a potential pressure-injury syndrome when the patient has acute clinical deterioration or findings concerning for colonic ischemia, ulceration, or perforation. Persistent impacted stool can exceed colonic capillary perfusion pressure, producing ischemia, necrosis, and eventual stercoral perforation. [17]",
        "Obtain urgent cross-sectional abdominal imaging when perforation or another acute intra-abdominal process is clinically suspected, and involve surgery promptly when imaging or examination suggests perforation. Stercoral perforation requires operative management; reported mortality has been as high as 60% in perforation cases. [17]",
        "Use a lower threshold for escalation in older or bedridden patients, in whom stercoral complications are particularly described, but do not exclude this diagnosis solely because a patient is young or pregnant. In pregnancy, minimize ionizing radiation when feasible, but imaging remains clinically valuable when other modalities are inconclusive. [17]"
      ],
      "bullets": [
        "Suspected rectal or colonic perforation: urgent imaging and surgical consultation rather than repeated bedside evacuation attempts. [17]",
        "Concern for ischemic pressure injury: expedite definitive clearance and evaluate for complications before assigning symptoms to routine constipation. [17]"
      ],
      "subsections": [],
      "table": {
        "caption": "Escalation pathway for fecal impaction presentations. [17]",
        "columns": [
          "Clinical branch",
          "Immediate action",
          "What changes next"
        ],
        "rows": [
          [
            "No clinical concern for ischemia or perforation",
            "Confirm stool burden with abdominal and digital rectal examination. [18][22]",
            "Proceed with route-appropriate disimpaction and reassess clearance. [22][23]"
          ],
          [
            "Clinical concern for stercoral ulceration, necrosis, or perforation",
            "Obtain urgent abdominal imaging and seek surgical evaluation. [17]",
            "Manage as an acute intra-abdominal complication rather than uncomplicated constipation. [17]"
          ]
        ]
      }
    },
    {
      "id": "confirm-and-localize",
      "eyebrow": "Bedside diagnosis",
      "heading": "Confirm impaction and determine whether stool is rectal or proximal",
      "intro": "Localization determines whether manual, rectal, oral, or combined clearance is practical.",
      "paragraphs": [
        "Diagnose fecal impaction primarily by history and examination. A clinically used definition is a hard lower-abdominal mass on examination or a dilated rectum containing a large quantity of stool on rectal examination; pediatric literature similarly defines impaction as a large fecal mass found by abdominal palpation or rectal examination. [19][22]",
        "Perform digital rectal examination before anorectal instrumentation when feasible. It identifies fecal loading and can also detect stricture, bleeding, pain, anal sphincter weakness, sphincter defects, and dyssynergic evacuation; confirm that the patient can follow commands to squeeze and push, because this informs the likelihood of an evacuation disorder after clearance. [4]",
        "Document anal tone and anal wink when performing a rectal examination. These elements are incorporated into structured impaction assessments and provide a baseline when neurologic or anorectal dysfunction is clinically relevant. [22][24]",
        "Use abdominal radiography selectively when physical examination is limited, particularly in children with obesity or inability to cooperate with examination; it may help evaluate fecal impaction but does not replace a rectal examination when a rectal mass is suspected. [20]"
      ],
      "bullets": [
        "Palpable firm stool in the rectal vault: classify as rectal impaction and plan direct evacuation. [15][21]",
        "Hard lower-abdominal mass with no removable rectal mass: consider more proximal retained stool and use an oral or rectal clearance regimen with reassessment. [22]",
        "Pain, bleeding, stricture, or inability to safely perform rectal examination: do not force bedside evacuation; clarify anatomy and complication risk first. [4]"
      ],
      "subsections": [
        {
          "heading": "Do not misclassify overflow symptoms",
          "paragraphs": [
            "Fecal incontinence can coexist with constipation and evacuation disorders. In a patient with new or worsening leakage, perform abdominal and rectal examination for retained stool before escalating antidiarrheal or continence-directed treatment. [2][4]"
          ],
          "bullets": []
        }
      ],
      "table": {
        "caption": "Examination findings that direct the first disimpaction strategy. [4][15][22]",
        "columns": [
          "Finding",
          "Interpretation",
          "Next action"
        ],
        "rows": [
          [
            "Firm rectal stool mass",
            "Rectal impaction. [15][21]",
            "Manual disimpaction, using local measures as needed for tolerability. [15]"
          ],
          [
            "Dilated rectum with large stool burden",
            "Fecal impaction. [22]",
            "Select oral or rectal medication-based disimpaction; reassess for persistence. [22]"
          ],
          [
            "Weak squeeze or paradoxical/ineffective push",
            "Possible sphincter dysfunction or dyssynergic evacuation. [4]",
            "After clearance, pursue anorectal evaluation if constipation or incontinence persists. [4][8]"
          ],
          [
            "Stricture, bleeding, marked pain, or concerning abdominal findings",
            "Possible structural lesion or complication. [4]",
            "Pause routine bedside escalation and evaluate the underlying process. [4][17]"
          ]
        ]
      }
    },
    {
      "id": "disimpaction-strategy",
      "eyebrow": "Treatment",
      "heading": "Choose manual, rectal, or oral disimpaction by stool location and clinical tolerance",
      "intro": "The treatment endpoint is complete clearance with minimal discomfort, followed by repeat examination when impaction was documented.",
      "paragraphs": [
        "For a firm rectal impaction, perform manual disimpaction. Geriatric guidance specifically recommends manual disimpaction for firm rectal stool, using local measures; case-based reports also describe successful management with manual disimpaction plus oral polyethylene glycol and correction of hypokalemia. [15][9]",
        "When stool is not confined to a firm rectal mass, use an oral or rectal medication-based disimpaction regimen. Available approaches include polyethylene glycol, lactulose, suppositories, and enemas; management should adjust the agent, dose, and combination until complete disimpaction is achieved with minimal discomfort. [22][23]",
        "Do not assume that one treatment attempt has cleared the burden. Repeat abdominal and, when initially abnormal and clinically appropriate, rectal assessment after the regimen; structured protocols require re-evaluation for residual impaction before moving forward with subsequent constipation-directed treatment. [22][24]",
        "Correct identifiable contributors that impede clearance. In one reported high-grade impaction, hypokalemia was corrected alongside manual disimpaction and oral polyethylene glycol; electrolyte abnormalities should therefore be identified and addressed when present during clinically significant impaction. [9]"
      ],
      "bullets": [
        "Firm stool in the rectal vault: manual disimpaction is the primary mechanical intervention. [15][21]",
        "Broader stool burden or incomplete clearance after direct evacuation: add oral or rectal laxative-based therapy and reassess. [22][23]",
        "Persistent fecal mass after an initial regimen: adjust route, dose, or combination rather than proceeding as though disimpaction is complete. [23]",
        "Severe impaction not manageable safely at the bedside: escalation to manual disimpaction under general anesthesia has been described as a last-resort approach. [12][13]"
      ],
      "subsections": [
        {
          "heading": "Pediatric dosing evidence",
          "paragraphs": [
            "For children with fecal impaction, high-dose oral polyethylene glycol is a first-line regimen in pediatric guidance: 1 to 1.5 g/kg/day for 3 to 6 days. Another pediatric hospital-medicine source specifies a maximum of 100 g/day and continuation until completely liquid stools are achieved. [8][14]"
          ],
          "bullets": [
            "Pediatric fecal impaction: polyethylene glycol 1 to 1.5 g/kg/day orally for 3 to 6 days; one source caps the daily dose at 100 g/day. [8][14]",
            "Pediatric alternative: high-dose polyethylene glycol or enemas may be used for disimpaction. [10]"
          ]
        },
        {
          "heading": "When manual evacuation requires escalation",
          "paragraphs": [
            "Reserve manual disimpaction under general anesthesia for situations in which high-dose oral laxatives or enemas have not achieved clearance or direct manipulation cannot be performed safely or tolerably. This is characterized as a last-resort approach in pediatric transanal-irrigation consensus guidance; anesthesia-supported manual disimpaction has also been used for difficult rectal impaction. [12][13]"
          ],
          "bullets": []
        }
      ],
      "table": {
        "caption": "Route selection for disimpaction. [8][10][12][15][22][23]",
        "columns": [
          "Clinical situation",
          "Preferred initial approach",
          "Reassessment or escalation"
        ],
        "rows": [
          [
            "Firm rectal mass",
            "Manual disimpaction with local measures for tolerability. [15]",
            "Add oral or rectal therapy if residual stool burden remains. [22][23]"
          ],
          [
            "Fecal loading without a readily removable rectal mass",
            "Oral or rectal medication-based regimen, including polyethylene glycol, lactulose, suppository, or enema options. [22]",
            "Adjust choice, dose, or combination until complete disimpaction. [23]"
          ],
          [
            "Child with fecal impaction",
            "Oral polyethylene glycol 1 to 1.5 g/kg/day for 3 to 6 days; enemas are an alternative. [8][10]",
            "Escalate refractory cases to other approaches, with manual disimpaction under general anesthesia as a last resort. [12]"
          ],
          [
            "Unsafe, intolerable, or refractory rectal impaction",
            "Consider anesthesia-supported manual disimpaction. [12][13]",
            "Reassess for complications and establish prevention after clearance. [17][22]"
          ]
        ]
      }
    },
    {
      "id": "post-clearance-prevention",
      "eyebrow": "After clearance",
      "heading": "Prevent recurrence by separating ongoing constipation from evacuation dysfunction",
      "intro": "A successful bowel movement is not sufficient evidence that the impaction and its drivers have resolved.",
      "paragraphs": [
        "Confirm that impaction has resolved before initiating or escalating longer-term constipation therapy. Clinical trial protocols repeat fecal-impaction assessment after treatment and require absence of impaction before subsequent intervention; this is a practical safeguard against treating maintenance symptoms while retained stool persists. [22][24]",
        "For ongoing constipation after clearance, identify whether the dominant problem is impaired evacuation rather than inadequate stool softening or transit. In patients whose typical symptoms persist despite empiric dietary, lifestyle, and laxative therapy, anorectal manometry and balloon expulsion testing are identified as the next management step; digital rectal examination may already show dyssynergia or weak sphincters. [4][8]",
        "Reassess patients with leakage after disimpaction rather than presuming primary fecal incontinence. Constipation, fecal incontinence, and evacuation disorders commonly coexist, so the post-clearance examination and symptom pattern should determine whether to pursue continence evaluation, anorectal testing, or continued constipation management. [2][4]"
      ],
      "bullets": [
        "Persistent difficult evacuation after documented clearance: perform anorectal manometry and balloon expulsion testing when empiric constipation treatment has failed. [8]",
        "Persistent incontinence with no retained stool: use examination findings, including sphincter strength and structural abnormalities, to direct anorectal evaluation. [4]",
        "Recurrent impaction: reassess for fecal loading rather than simply increasing a maintenance regimen. [22][23]"
      ],
      "subsections": [],
      "table": {
        "caption": "Post-disimpaction decisions. [4][8][22][24]",
        "columns": [
          "Post-clearance finding",
          "Interpretation",
          "Next step"
        ],
        "rows": [
          [
            "Residual rectal or abdominal stool burden",
            "Incomplete disimpaction. [22][24]",
            "Continue or modify oral, rectal, or manual clearance strategy. [22][23]"
          ],
          [
            "Persistent constipation despite empiric therapy",
            "Possible evacuation disorder. [8]",
            "Order anorectal manometry and balloon expulsion testing. [8]"
          ],
          [
            "Leakage persists after stool clearance",
            "Constipation-associated overflow has not fully explained symptoms; sphincter or evacuation dysfunction may coexist. [2][4]",
            "Repeat anorectal examination and direct further anorectal evaluation by findings. [4]"
          ]
        ]
      }
    }
  ],
  "faq": [],
  "references": [
    {
      "number": 1,
      "title": "Irritable Bowel Syndrome - The New England Journal of Medicine",
      "detail": "www.nejm.org",
      "url": "https://www.nejm.org/doi/pdf/10.1056/NEJM199312233292608",
      "authors": "www.nejm.org",
      "host": "www.nejm.org"
    },
    {
      "number": 2,
      "title": "Prevention of Fecal and Urinary Incontinence in Adults - ACP Journals",
      "detail": "www.acpjournals.org",
      "url": "https://www.acpjournals.org/doi/10.7326/0003-4819-148-6-200803180-00210",
      "authors": "www.acpjournals.org",
      "host": "www.acpjournals.org"
    },
    {
      "number": 3,
      "title": "Treatment of Constipation and Fecal Incontinence in Stroke Patients",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/abs/10.1161/01.str.0000144684.46826.62",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org"
    },
    {
      "number": 4,
      "title": "Advances in the evaluation of anorectal function | Nature Reviews Gastroenterology & Hepatology",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/nrgastro.2018.27",
      "authors": "www.nature.com",
      "host": "www.nature.com"
    },
    {
      "number": 5,
      "title": "Constipation in Long-Term Care - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1525861007001739",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 6,
      "title": "Chronic Constipation - an overview | ScienceDirect Topics",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/chronic-constipation",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 7,
      "title": "Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S0923753419316977",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 8,
      "title": "Functional Constipation - an overview",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/functional-constipation",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 9,
      "title": "High‐Grade Rectal Impaction by Feces and Oral Contrast: Case ...",
      "detail": "agsjournals.onlinelibrary.wiley.com",
      "url": "https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.13143",
      "authors": "agsjournals.onlinelibrary.wiley.com",
      "host": "agsjournals.onlinelibrary.wiley.com"
    },
    {
      "number": 10,
      "title": "European Society for Paediatric Gastroenterology, Hepatology and ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/jpn3.70447",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 11,
      "title": "Abstract - 2024 - JPGN Reports - Wiley Online Library",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/jpr3.12132",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 12,
      "title": "Consensus Review of Best Practice of Transanal Irrigation in Children",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1097/MPG.0000000000001483",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 13,
      "title": "Fecal Impaction in the Rectum and Rectosigmoid Colon Secondary ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1155/2021/4826867",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 14,
      "title": "Things We Do for No Reason™: Routinely hospitalizing children ...",
      "detail": "shmpublications.onlinelibrary.wiley.com",
      "url": "https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.12959",
      "authors": "shmpublications.onlinelibrary.wiley.com",
      "host": "shmpublications.onlinelibrary.wiley.com"
    },
    {
      "number": 15,
      "title": "Constipation in the Elderly - Harari - American Geriatrics Society",
      "detail": "agsjournals.onlinelibrary.wiley.com",
      "url": "https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.1993.tb06463.x",
      "authors": "agsjournals.onlinelibrary.wiley.com",
      "host": "agsjournals.onlinelibrary.wiley.com"
    },
    {
      "number": 16,
      "title": "Prevalence and factors associated with faecal impaction in the ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/ageing/article/46/1/119/2605722",
      "authors": "academic.oup.com",
      "host": "academic.oup.com"
    },
    {
      "number": 17,
      "title": "Stercoral Ulcer Perforation in a Young Woman at 29 Weeks Gestation Treated with Sigmoid Colectomy and Colostomy Creation | ACS",
      "detail": "www.facs.org",
      "url": "https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v5n1/12-wells-perforated-stercoral-ulcer",
      "authors": "www.facs.org",
      "host": "www.facs.org"
    },
    {
      "number": 18,
      "title": "Constipation",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/pediatricsinreview/article-pdf/41/8/379/1279150/pedsinreview_20180334.pdf",
      "authors": "publications.aap.org",
      "host": "publications.aap.org"
    },
    {
      "number": 19,
      "title": "Rectal Fecal Impaction Treatment in Childhood Constipation",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/pediatrics/article/124/6/e1108/72199/Rectal-Fecal-Impaction-Treatment-in-Childhood",
      "authors": "publications.aap.org",
      "host": "publications.aap.org"
    },
    {
      "number": 20,
      "title": "Philip, a 7-Year-Old Boy with Intermittent Abdominal Pain",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/aapbooks/monograph/718/chapter/10090908/Philip-a-7-Year-Old-Boy-with-Intermittent",
      "authors": "publications.aap.org",
      "host": "publications.aap.org"
    },
    {
      "number": 21,
      "title": "An Occurrence of Sepsis During Inpatient Fecal Disimpaction",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/pediatrics/article/133/1/e235/68354/An-Occurrence-of-Sepsis-During-Inpatient-Fecal",
      "authors": "publications.aap.org",
      "host": "publications.aap.org"
    },
    {
      "number": 22,
      "title": "[PDF] NCT04110145 - ClinicalTrials.gov",
      "detail": "cdn.clinicaltrials.gov",
      "url": "https://cdn.clinicaltrials.gov/large-docs/45/NCT04110145/Prot_000.pdf",
      "authors": "cdn.clinicaltrials.gov",
      "host": "cdn.clinicaltrials.gov"
    },
    {
      "number": 23,
      "title": "Scenario: Adults | Management | Constipation - CKS - NICE",
      "detail": "cks.nice.org.uk",
      "url": "https://cks.nice.org.uk/topics/constipation/management/adults",
      "authors": "cks.nice.org.uk",
      "host": "cks.nice.org.uk"
    },
    {
      "number": 24,
      "title": "[PDF] Title Page - ClinicalTrials.gov",
      "detail": "cdn.clinicaltrials.gov",
      "url": "https://cdn.clinicaltrials.gov/large-docs/58/NCT04166058/Prot_000.pdf",
      "authors": "cdn.clinicaltrials.gov",
      "host": "cdn.clinicaltrials.gov"
    }
  ],
  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
  "citations": [
    {
      "number": 1,
      "title": "Irritable Bowel Syndrome - The New England Journal of Medicine",
      "detail": "www.nejm.org",
      "url": "https://www.nejm.org/doi/pdf/10.1056/NEJM199312233292608",
      "authors": "www.nejm.org",
      "host": "www.nejm.org",
      "snippet": "predicting irritable bowel syndrome … pseudo-obstruction, idiopathic Fecal impaction, with irritable bowel syndrome. CT. Non-colonic",
      "score": 0.35193497
    },
    {
      "number": 2,
      "title": "Prevention of Fecal and Urinary Incontinence in Adults - ACP Journals",
      "detail": "www.acpjournals.org",
      "url": "https://www.acpjournals.org/doi/10.7326/0003-4819-148-6-200803180-00210",
      "authors": "www.acpjournals.org",
      "host": "www.acpjournals.org",
      "snippet": "Fecal incontinence is a syndrome that involves the unintentional loss of solid or liquid stool. Although fecal incontinence affects individuals",
      "score": 0.18242586
    },
    {
      "number": 3,
      "title": "Treatment of Constipation and Fecal Incontinence in Stroke Patients",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/abs/10.1161/01.str.0000144684.46826.62",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "A single clinical/educational nurse intervention in stroke patients effectively improved symptoms of bowel dysfunction up to 6 months later,",
      "score": 0.13579291
    },
    {
      "number": 4,
      "title": "Advances in the evaluation of anorectal function | Nature Reviews Gastroenterology & Hepatology",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/nrgastro.2018.27",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "example, faecal incontinence in a patient presenting with constipation) as data increasingly suggest that both faecal incontinence and evacuation disorders commonly coexist21.\"). Also, anorectal evaluation begins with a carefully performed digital rectal examination that can reveal several abnormali",
      "score": 0.26649848
    },
    {
      "number": 5,
      "title": "Constipation in Long-Term Care - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1525861007001739",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "### Am J Med\n\n### Lane P, Panke J, Lyman PManagement of constipation in residents with dementia: Sorbitol effectiveness and cost\n\n### J Am Med Dir Assoc\n\n### Effect of tegaserod in chronic constipation: A randomized, double-blind, controlled trial\n\n### Clin Gastroenterol Hepat\n\n### Constipation in t",
      "score": 0.4186262
    },
    {
      "number": 6,
      "title": "Chronic Constipation - an overview | ScienceDirect Topics",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/chronic-constipation",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "therapeutic options should be included in diagnostic and therapeutic algorithms. The aim of this review is to perform a critical evaluation of the current diagnostic and therapeutic options available for adult patients with chronic constipation in order to identify a rational patient approach; furth",
      "score": 0.40218133
    },
    {
      "number": 7,
      "title": "Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S0923753419316977",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eoCRC patients. The DIRECt group produced the first consensus recommendations on eoCRC. All statements should be considered together with the accomp",
      "score": 0.36296973
    },
    {
      "number": 8,
      "title": "Functional Constipation - an overview",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/functional-constipation",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Functional constipation is associated with infrequent or painful defecation, fecal incontinence, and abdominal pain and is a common problem in childhood that often starts during the first year of life . The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition and the North Ame",
      "score": 0.33463344
    },
    {
      "number": 9,
      "title": "High‐Grade Rectal Impaction by Feces and Oral Contrast: Case ...",
      "detail": "agsjournals.onlinelibrary.wiley.com",
      "url": "https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.13143",
      "authors": "agsjournals.onlinelibrary.wiley.com",
      "host": "agsjournals.onlinelibrary.wiley.com",
      "snippet": "The fecal impaction was successfully treated with manual disimpaction, oral polyethylene glycol, and correction of hypokalemia and",
      "score": 0.7152057
    },
    {
      "number": 10,
      "title": "European Society for Paediatric Gastroenterology, Hepatology and ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/jpn3.70447",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "The GDG suggests that high dose polyethylene glycol (PEG) or enemas can be used as treatment options for fecal impaction. The GDG also",
      "score": 0.6301622
    },
    {
      "number": 11,
      "title": "Abstract - 2024 - JPGN Reports - Wiley Online Library",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/jpr3.12132",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "... treatment guidelines recommend polyethylene glycol 3350 (PEG) ... Manual Fecal Disimpactions: Patients who required a manual fecal disimpaction",
      "score": 0.5457947
    },
    {
      "number": 12,
      "title": "Consensus Review of Best Practice of Transanal Irrigation in Children",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1097/MPG.0000000000001483",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "Fecal impaction before starting TAI can be treated with high-dose oral laxatives, enemas, or, as a last resort, manual disimpaction under general anesthesia (",
      "score": 0.53866833
    },
    {
      "number": 13,
      "title": "Fecal Impaction in the Rectum and Rectosigmoid Colon Secondary ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1155/2021/4826867",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "In patients with rectal seed impaction, manual disimpaction under general anesthesia has been the preferred treatment to minimize patient",
      "score": 0.4627892
    },
    {
      "number": 14,
      "title": "Things We Do for No Reason™: Routinely hospitalizing children ...",
      "detail": "shmpublications.onlinelibrary.wiley.com",
      "url": "https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.12959",
      "authors": "shmpublications.onlinelibrary.wiley.com",
      "host": "shmpublications.onlinelibrary.wiley.com",
      "snippet": "Start with first-line therapy for fecal impaction of high-dose PEG (1−1.5 g/kg/day; maximum 100 g/day) until achieving completely liquid stools",
      "score": 0.37669244
    },
    {
      "number": 15,
      "title": "Constipation in the Elderly - Harari - American Geriatrics Society",
      "detail": "agsjournals.onlinelibrary.wiley.com",
      "url": "https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.1993.tb06463.x",
      "authors": "agsjournals.onlinelibrary.wiley.com",
      "host": "agsjournals.onlinelibrary.wiley.com",
      "snippet": "The use of enemas for high disimpaction is discussed below; in patients who have a firm rectal impaction, manual disimpaction should be performed, using local",
      "score": 0.36765668
    },
    {
      "number": 16,
      "title": "Prevalence and factors associated with faecal impaction in the ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/ageing/article/46/1/119/2605722",
      "authors": "academic.oup.com",
      "host": "academic.oup.com",
      "snippet": "At least 53 people reported FI within the past year (5.3% (CI 95%: 3.9–6.7%)). Only 0.03% met criteria for chronic constipation and faecal",
      "score": 0.3018871
    },
    {
      "number": 17,
      "title": "Stercoral Ulcer Perforation in a Young Woman at 29 Weeks Gestation Treated with Sigmoid Colectomy and Colostomy Creation | ACS",
      "detail": "www.facs.org",
      "url": "https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v5n1/12-wells-perforated-stercoral-ulcer",
      "authors": "www.facs.org",
      "host": "www.facs.org",
      "snippet": "### Discussion\n\nConstipation, characterized by hard stools, infrequent bowel movements, or difficulty with stool passage, is a common affliction. While often uncomfortable, chronic constipation can lead to serious complications. Fecal impaction, if untreated, can progress to ulceration, necrosis, an",
      "score": 0.43352634
    },
    {
      "number": 18,
      "title": "Constipation",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/pediatricsinreview/article-pdf/41/8/379/1279150/pedsinreview_20180334.pdf",
      "authors": "publications.aap.org",
      "host": "publications.aap.org",
      "snippet": "Diagnosis of fecal impaction has histor- ically been made based on appropriate history and digital rectal examination. The role of the digital rectal",
      "score": 0.5832277
    },
    {
      "number": 19,
      "title": "Rectal Fecal Impaction Treatment in Childhood Constipation",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/pediatrics/article/124/6/e1108/72199/Rectal-Fecal-Impaction-Treatment-in-Childhood",
      "authors": "publications.aap.org",
      "host": "publications.aap.org",
      "snippet": "Dec 1, 2009 — Fecal impaction has been defined as a large fecal mass, noted through either abdominal palpation or rectal examination, which is unlikely to be ...Read more",
      "score": 0.41122967
    },
    {
      "number": 20,
      "title": "Philip, a 7-Year-Old Boy with Intermittent Abdominal Pain",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/aapbooks/monograph/718/chapter/10090908/Philip-a-7-Year-Old-Boy-with-Intermittent",
      "authors": "publications.aap.org",
      "host": "publications.aap.org",
      "snippet": "Abdominal radiograph is a low-cost, low-risk study that is useful to evaluate fecal impaction, especially in a child who has obesity or who is unable to",
      "score": 0.3846353
    },
    {
      "number": 21,
      "title": "An Occurrence of Sepsis During Inpatient Fecal Disimpaction",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/pediatrics/article/133/1/e235/68354/An-Occurrence-of-Sepsis-During-Inpatient-Fecal",
      "authors": "publications.aap.org",
      "host": "publications.aap.org",
      "snippet": "Jan 1, 2014 — A digital rectal examination revealed no strictures or masses other than palpable firm stool in the rectal vault, and stool was present",
      "score": 0.34727195
    },
    {
      "number": 22,
      "title": "[PDF] NCT04110145 - ClinicalTrials.gov",
      "detail": "cdn.clinicaltrials.gov",
      "url": "https://cdn.clinicaltrials.gov/large-docs/45/NCT04110145/Prot_000.pdf",
      "authors": "cdn.clinicaltrials.gov",
      "host": "cdn.clinicaltrials.gov",
      "snippet": "If fecal impaction is identified at Screening (Visit 1), participants will receive a disimpaction regimen with either oral or rectal medication. The choice of treatment will be determined by the investigator after discussing the options with the participant and the caregiver. Options will include an",
      "score": 0.5608546
    },
    {
      "number": 23,
      "title": "Scenario: Adults | Management | Constipation - CKS - NICE",
      "detail": "cks.nice.org.uk",
      "url": "https://cks.nice.org.uk/topics/constipation/management/adults",
      "authors": "cks.nice.org.uk",
      "host": "cks.nice.org.uk",
      "snippet": "The aim of management of faecal loading and/or impaction is to achieve complete disimpaction with minimal discomfort. Adjust the dose, choice, and combination",
      "score": 0.55391616
    },
    {
      "number": 24,
      "title": "[PDF] Title Page - ClinicalTrials.gov",
      "detail": "cdn.clinicaltrials.gov",
      "url": "https://cdn.clinicaltrials.gov/large-docs/58/NCT04166058/Prot_000.pdf",
      "authors": "cdn.clinicaltrials.gov",
      "host": "cdn.clinicaltrials.gov",
      "snippet": "of anal wink and normal anal tone. If fecal impaction is identified at the Screening Visit (Visit 1), Visit 1 and Visit 2 cannot be combined. Participants will receive a disimpaction regimen with either oral or rectal medication. The choice of treatment will be determined by the investigator after d",
      "score": 0.49084634
    }
  ],
  "publishedAt": "2026-09-16T00:56:13.802164+00:00",
  "updatedAt": "2026-09-16T00:56:13.802164+00:00",
  "readingMinutes": 5,
  "slug": "fecal-impaction"
}