Faecal impaction in palliative care
For information on general management of constipation and laxatives used in palliative care, see Management of constipation in palliative care.
Unrelieved constipation may result in faecal impaction, which is seen as constipation with overflow of faecal fluid. Impaction is due mainly to the patient’s inability to sense and respond to the presence of stool in the rectum.
Oral therapy with macrogol 3350 can be used for faecal disimpaction, particularly if rectal therapy is contraindicated (eg in patients with severe neutropenia), but it can take 2 to 3 days to have an effect. A suitable regimen is:
macrogol 33501, for example: macrogol
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.Australian Medicines Handbook (AMH), 2023National Institute for Health and Care Excellence (NICE), 2022
For patients with hard faeces, 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:
glycerol 2.8 g suppository rectally, as a single dose. glycerol
Once the rectum has been cleared, manage as for constipation with hard faeces in the rectum in palliative care.
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
Digitally removing impacted hard rectal faeces may be necessary before laxatives can be effective. Ensure adequate management of pain and anxiety before performing the procedure; see Incident pain in palliative care.
If impaction does not resolve with the above measures, seek specialist advice.
After impaction resolves, review the patient’s regular laxative regimen and modify if necessary, or consider starting a regular regimen to prevent recurrence.