Constipation : Faecal loading impaction management in adults

The management of faecal loading, a common yet challenging clinical condition characterized by the accumulation of dry, hard stool in the colon and rectum, necessitates a strategic and patient-centered approach. The primary goal in managing faecal loading and/or impaction is to achieve complete disimpaction while ensuring the patient experiences minimal discomfort. This objective underscores the importance of a tailored therapeutic regimen, which involves adjusting the dose, choice, and combination of laxatives based on the patient's response to treatment and personal preferences.

Upon comprehensive assessment of the patient, the management strategy can be delineated as follows:

• For patients presenting with hard stools, a high dose of an oral macrogol is often considered the initial step to soften the stool and facilitate its passage.
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• In instances where stools remain soft, or if hard stools persist after a few days of oral macrogol treatment, the introduction or addition of an oral stimulant laxative may be warranted to promote bowel movement.
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• Should the response to oral laxatives prove inadequate or progress too slowly, further intervention with a rectal approach may be necessary. This includes the use of suppositories, such as bisacodyl for soft stools or a combination of glycerol alone, or glycerol plus bisacodyl...