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Constipation - Management
How should I manage faecal loading/impaction in adults?
- For hard stools, consider using a high dose of an oral macrogol (licensed for use in faecal loading/impaction).
- For soft stools or, for hard stools, after a few days treatment with a macrogol, consider starting or adding an oral stimulant laxative.
- If the response to oral laxatives is insufficient or not fast enough, consider:
- Using a suppository: bisacodyl for soft stools; glycerol alone or glycerol plus bisacodyl for hard stools.
- Using a mini enema — docusate (softener and weak stimulant) or sodium citrate (osmotic).
- If the response is still insufficient:
- Consider using a sodium phosphate or arachis oil retention enema (place high if the rectum is empty but the colon is full).
- For hard faeces it can be helpful to give the arachis oil enema overnight before giving a sodium phosphate (large volume) or sodium citrate (small volume) enema the next day.
- Enemas may need to be repeated several times to clear hard impacted faeces.
- The choice depends on individual preference and what has previously been tried.
- Regular use of a laxative may be needed after the faecal loading/impaction has been cleared.
In depth
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