Faecal impaction in adults
For faecal impaction (confirmed by rectal examination), macrogol 3350 can be used for faecal disimpaction, but it can take 2 to 3 days to have an effect. A suitable regimen is:
Movicol (with electrolytes) 13.12 g per sachet, use 4 to 8 sachets (mix each sachet with 125 mL of water) orally, daily for up to 3 days.
Rectal therapy using a suppository or enema can be used; this clears the rectum by softening the stool and irritating the bowel, increasing peristaltic activity and stool movement. Suitable initial therapy is:
If the above therapy is ineffective, add an osmotic enema; use:
sorbitol+sodium citrate+sodium lauryl sulfoacetate enema rectally, as a single dose2. sorbitol + sodium citrate + sodium lauryl sulfoacetate enema sorbitol+sodium citrate+sodium lauryl sulfoacetate sorbitol+sodium citrate+sodium lauryl sulfoacetate
Sodium phosphate–based enemas may be used for refractory cases, but repeated use is not recommended because of potential fluid shifts, electrolyte disturbance and kidney impairment.
Manual disimpaction may be beneficial.
If the above therapy does not resolve faecal impaction, the patient may require admission to hospital for further management.
When impaction has resolved, consider the need for maintenance laxative therapy—see Stepwise approach to laxative therapy for adults.