Know the medical approach to treat fecal retention and find relief to awkward symptoms.

Fecal retention is a frequent and annoying condition that is characterized by the accumulation of hardened feces in the rectum or colon. It occurs when the feces are compacted and cannot be expelled naturally from the body. This condition can cause serious discomfort, pain and even intestinal obstruction if not. Fortunately, there are several methods to effectively manage and treat fecal retention, guaranteeing the relief of patients.

Oral laxatives: One of the main methods of treatment of fecal retention is the use of oral laxatives. These medications stimulate intestinal movement and soften the feces, facilitating their evacuation. Among the oral laxatives that are most frequently included:

1. Stimulant laxatives: These medications act irritating the intestinal mucosa, favoring contractions and increasing intestinal movements. Some examples are bisacodile and Sen.
2. Osmotic laxatives: These laxatives help introduce water into the intestines, softening the feces and facilitating their evacuation. The most used osmotic laxatives are polyethylene glycol and lactulose.
3. Volume forming laxatives: These laxatives increase the volume and moisture content of the feces, favoring the regularity of the depositions. Psilio and Methylcelulose peel are common examples of volum e-forming laxatives.

Tip: It is important to mention that laxatives should always be used under the supervision of a healthcare professional. They should be taken according to the indications and with a sufficient fluid intake to avoid dehydration.

Manual disappointment: When the fecal impact is serious or does not respond to oral laxatives, manual disimpactation may be necessary. This procedure consists in the physical extraction of retained feces using gloved fingers or specialized instruments. Manual disappointed must be carried out by a qualified healthcare professional to minimize the risk of injuries or complications.

Treating Fecal Impaction

1. Non-pharmacological treatments:

• Dietary modifications: A diet rich in fiber can help soften stools and promote regular bowel movements. It is recommended to increase the intake of fruits, vegetables, whole grains and legumes.
• Fluid intake: Staying hydrated is essential to maintaining optimal bowel function. Drinking plenty of water throughout the day can help soften stool and make it easier to pass.
• Physical activity: Regular exercise stimulates bowel movements and helps prevent fecal impaction. Performing activities such as walking or running can improve intestinal motility.

Note: It is important to consult with a healthcare professional before making any changes to diet or exercise, especially for people with underlying medical conditions.

2. Pharmacological treatments:

1. Laxatives: There are different types of laxatives that can be used to treat fecal impaction. Bulk-forming laxatives, such as psyllium or methylcellulose, can help soften stools and promote evacuation. Stimulant laxatives, such as bisacodyl or senna, stimulate the muscles of the intestine and help pass stool.
2. Enemas: Enemas consist of the introduction of a liquid solution into the rectum to stimulate bowel movements. Saline or mineral oil enemas can be used to soften retained stool and facilitate its evacuation.
3. Digital removal: In severe cases of fecal impaction, manual disimpaction may be necessary. This procedure involves using gloved fingers to remove hardened stool from the rectum.

Caution: Digital extraction should only be performed by a qualified healthcare professional to avoid injury or complications.

Understanding Fecal Impaction: Causes and Symptoms

Causes of fecal impaction:

• Prolonged constipation: When fecal matter remains in the colon for a long period of time, it becomes dry and hard, making it difficult to expel.
• Inadequate fiber intake: A diet low in fiber can contribute to constipation and increase the risk of fecal impaction.
• Dehydration: Insufficient fluid intake can cause harder, drier stools, making it difficult to pass.
• Decreased mobility: physical inactivity or bed for prolonged periods can slow down intestinal movements, which causes fecal impact.

It is important to know the symptoms that may indicate the presence of fecal retention. These symptoms may vary depending on the severity of retention and the person, but the most common signs are the following

1. Abdominal discomfort: Patients may experience pain, cramps or feeling of fullness in the abdomen.
2. Rectal hemorrhage: The effort to expel hard stool can cause small tears in the rectum, which causes bleeding.
3. Constipation: There may be rare deposits, difficulty evacuating or sensation of incomplete evacuation.
4. Rectal pressure: feeling of constant need to defecate, even after trying to do so.
5. Gases and smelly feces: the prolonged presence of fecal matter in the colon can cause an unpleasant smell.

Early recognition and proper treatment of fecal retention are crucial to prevent complications such as fecal incontinence, rectal prolapse or intestinal obstruction.

Therefore, people who experience fecal retention symptoms should quickly seek medical attention. A healthcare professional can diagnose fecal retention through a physical exam and recommend other tests, such as radiographs or rectal touch, to determine the scope of retention. Treatment options may vary depending on the severity of retention and may include lifestyle modifications, diet changes, medication and manual extraction of stool retained under medical supervision.

Diagnosing Fecal Impaction: Medical Evaluation and Tests

During the medical evaluation, health professionals evaluate the patient’s medical history, including previous episodes of constipation or fecal impact, the medications he takes and their dietary habits. They also perform a physical examination to evaluate the abdomen in search of sensitivity or distension, evaluate the rectum in search of hard stools and detect signs of complications such as abdominal pain, swelling or vomiting.

Diagnostic tests of fecal impact:

1. Anorectal exam: also known as rectal touch, this test consists of introducing an inguanta finger and lubricated in the rectum to feel if there are hardened feces. The doctor can also evaluate muscle tone and check if there is any anomaly.
2. Abdominal radiography: An abdomen radiography can help visualize the extension and location of fecal impact. It can also help identify any complication, such as intestinal obstruction.
3. Rectal touch with sigmoidoscopy: This procedure implies the use of a sigmoidoscope, a flexible tube with a camera, to examine the rectum and lower part of the colon. It allows the doctor to directly visualize the feces and evaluate any obstruction or anomaly.

It is essential to diagnose fecal retention promptly to prevent complications and provide proper treatment. The medical evaluation, which includes a complete Anamnesis and physical examination, together with diagnostic tests such as anorectal examination, abdominal radiography and rectal touch with sigmoidoscopy, help to accurately diagnose fecal retention and plan treatment.

Non-Invasive Treatment Options for Fecal Impaction

In cases of fecal retention, in which hardened feces accumulate in the rectum and colon, no n-invasive treatment options can provide effective relief without invasive procedures. These treatment options are aimed at soften feces, promote regular intestinal movements and relieve discomfort, all minimizing patient discomfort and promoting general wel l-being. Next, we deepen some no n-invasive approaches that health professionals can take into account when treating fecal retention.

1. Dietary modifications: One of the first steps to treat fecal impact in a no n-invasive way is to make diet modifications. A fibe r-rich diet is recommended, since it helps increase the volume and softness of the feces. Patients should consume fibe r-rich foods, such as fruits, vegetables, whole grains and legumes. In addition, it is important to increase fluid intake to help hydration, intestine lubrication and feces softening. This may include water consumption, infusions and clear broths.

Note: American food guides recommend a daily 25 grams fiber intake for women and 38 grams for men. However, people with fecal impact can benefit from greater fiber intake, under medical supervision.

2. Medication: certain medications can be prescribed to facilitate the passage of feces and relieve fecal retention. Stool softeners, such as sodium docusato, act allowing water to penetrate the stool, making them softer and easier to evacuate. In some cases, laxatives, such as osmotic or stimulating laxatives, may be recommended to favor evacuation. It is important to consult a health professional before taking any medication to ensure that the dose is adequate and that it adapts to each case.

CAUTION: Excessive or incorrect use of laxatives can cause dependence and electrolytic imbalances. Always follow the instructions of the health professional and the recommended dose.

Treating fecal impaction requires a multidimensional approach.

3. 3. Physical activity: physical activity can help relieve fecal retention, since it stimulates intestinal motility and intestinal movements. Regular exercise, such as walking or footing, can favor peristalsism and reduce constipation. In addition, incorporating exercises aimed at abdominal muscles, such as pelvic inclination exercises or yoga postures, can help strengthen pelvic soil muscles and improve intestinal function.

Invasive Treatment Options for Severe Fecal Impaction

Invasive treatment options for severe fecal impact may include:

• Digital disappointment: This procedure consists in the manual extraction of the stool retained in the rectum. It is usually done by a healthcare professional with swan and lubricated fingers. Digital withdrawal is usually considered when other methods have failed or if there is an urgent need to relieve symptoms quickly. However, only medical personnel formed to minimize the risk of injuries or complications must be performed.
• Enemas administration: enemas consist of the introduction of liquid or gas in the rectum to soften the feces and stimulate the intestinal movement. Different types of enemas can be used, such as saline solution, mineral or osmotic oil. These solutions help soften hardened feces, facilitating their evacuation. Enemas can be administered by a health or sel f-administered professional at home under medical supervision.

Note: Both digital disimpactation and enemas administration should always be carried out with caution and under the supervision of a healthcare professional. They can cause discomfort and carry potential risks, such as rectal bleeding or drilling of the rectum. It is important to comment on the risks and benefits of these invasive treatments with a medical professional before proceeding.

In some cases, a combination of these invasive treatment options can be used to effectively relieve severe fecal retention. However, it is essential to address the underlying causes of fecal retention and apply preventive measures to avoid future episodes. Maintaining a balanced diet, hydrating and performing physical activity regularly can contribute to a healthy intestinal function and minimize the risk of fecal impact.

Preventing Fecal Impaction in the Future

1. Maintain a balanced diet: A healthy diet plays an important role in preventing fecal impaction. Include plenty of fiber-rich foods, such as fruits, vegetables, whole grains, and legumes, in your daily meals. Fiber provides volume to the stool and facilitates its passage through the digestive tract. Additionally, staying well hydrated by consuming an adequate amount of water throughout the day can also promote regular bowel movements.

Fiber-rich foods:

• Apples
• Pears
• Broccoli
• Carrots
• Oatmeal
• Quinoa
• Lentils

2. Establish a regular bowel routine: Develop a consistent bowel movement schedule by setting aside time each day for this essential bodily function. Listen to your body’s natural signals and avoid ignoring the urge to defecate. Creating a regular bowel routine helps train the digestive system to operate on a predictable schedule, minimizing the risk of constipation and fecal impaction.

3. Stay physically active: Engaging in regular physical activity not only benefits your overall health, but also helps prevent fecal impaction. Exercise stimulates the intestinal muscles, promoting regular contractions that improve the movement of stool. Aim for at least 30 minutes of moderate-intensity exercise, such as brisk walking, swimming, or cycling, most days of the week.

Exercise ideas:

1. 30 minutes of fast walking
2. 20 minute swim session
3. 40 minutes of cycling exercise

By following these preventive measures, people can significantly reduce the risk of developing fecal impaction in the future, ensuring a healthy and regular digestive system.

Dietary and Lifestyle Changes for Managing Fecal Impaction

Dietary modifications:

• Increase fiber intake: Consuming adequate amounts of dietary fiber is crucial to maintaining regular intestinal transit. Fiber adds volume to stool, making it easier to evacuate. Include foods such as fruits, vegetables, whole grains and legumes in your diet.
• Staying hydrated: Drinking enough water and fluids throughout the day helps soften stools and prevents dehydration, which can contribute to fecal impaction. Try to drink at least 8-10 glasses of water a day.
• Avoid constipating foods: Certain foods can exacerbate constipation and prevent regular bowel movements. Limit or avoid processed foods, high-fat foods, dairy products, and refined grains.

Pro tip: It is essential to gradually increase your fiber intake and maintain a balanced diet to avoid excess gas, bloating and discomfort.

Changes in lifestyle:

1. Regular exercise: Physical activity stimulates bowel movements and promotes overall intestinal health. Aim for at least 30 minutes of moderate exercise, such as brisk walking or cycling, most days of the week.
2. Establish a regular bathroom routine: Set aside time each day to defecate, preferably after meals, when the body naturally stimulates the urge to defecate. Avoid delaying or ignoring the urge to defecate.

When to Seek Medical Help for Fecal Impaction Complications

If you experience any of the following symptoms, it is important that you seek medical help to treat complications of fecal impaction:

1. Severe abdominal pain: Severe, persistent abdominal pain may indicate a serious complication of fecal impaction. This pain may worsen with movement and pressure on the abdomen.

2. Bleeding from the rectum: The presence of blood in the stool or bleeding from the rectum may be a sign of tissue damage caused by impacted stool or other underlying conditions. It is essential that you be evaluated by a healthcare professional.

3. Vomiting: Frequent vomiting or the inability to keep food down may indicate that impaction is causing serious gastrointestinal upset. This can lead to dehydration and electrolyte imbalances that require medical attention.

If you experience severe abdominal pain, rectal bleeding, or vomiting, it is essential that you seek immediate medical attention to treat potential complications associated with fecal impaction.

In addition to the symptoms mentioned, other signs that medical help is needed include:

• Inability to defecate: If, despite attempts, you have not been able to pass stool for several days, it is necessary to consult a health professional.

• Signs of infection: The appearance of fever, chills, or abdominal swelling may suggest the presence of an infection related to fecal impaction. Immediate medical attention is required to avoid major complications.

• Worsening of existing diseases: Fecal impaction can aggravate pre-existing medical conditions such as hemorrhoids, diverticulosis or inflammatory bowel disease. If symptoms worsen, it is vital to seek medical help for proper treatment.

Knowing when to seek medical help for fecal impaction complications is crucial to preventing potential health risks and receiving timely treatment. It is always recommended to consult a healthcare professional for an accurate diagnosis and proper treatment of this condition.

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Author of the article

Dr.Greenblatt M.

Medical oncologist at the Robert Larner College of Medicine, MD, at the University of Vermont