Generally caused by chronic and obstinate constipation, fecaloma has an obstructive component, such that the fecal mass - hard and dry - that composes it cannot be evacuated spontaneously by the patient. It is therefore necessary to resort to adequate measures, such as softening with glycerin enemas and / or digital crushing, up to surgical intervention in the most complicated cases.
. The processes of reabsorption of water typical of the large intestine are thus enhanced: by depriving the fecal mass of the aqueous component, this becomes gradually harder and drier, predisposing to the development of fecal impaction. Among the risk factors we can therefore list the retention of stool for painful defecation associated with anal fissures, the presence of fistulas, hemorrhoids, dolicocolon (excessive length of the colon), and even the use of certain drugs (anticholinergics, opiates, such as codeine , oxycodone, hydrocodone, tramadol, drugs against diarrhea, aluminum, etc.). Prolonged bed rest of hospitalized patients, a low-liquid diet, vomiting and intense sweating can favor the onset of fecal impaction. Still on the dietary front, both a deficiency and an excess of fibers, especially if the latter is accompanied by a reduced water intake, can play an important role in the etiopathogenesis of fecal impaction.
Children and the elderly are among the categories of subjects at greatest risk, in addition to psychiatric patients and paraplegics.
which it is associated with. Characteristic is the sensation of rectal weight, tenesmus, abdominal pain and distension, with urinary retention, pollakiuria, nausea, vomiting and anorexia (although in the first stages fecal impaction can be symptomatic). The presence of a fecal impaction can also be signaled by the sudden release of liquid stools in small quantities (encopresis) or by the appearance of watery diarrhea, despite the underlying constipation.Regarding fecal impacts, it is necessary to distinguish between symptomatic and preventive treatment.
When the fecaloma is already formed, it is necessary to break it up; considering that in most cases the fecalomas are located in the rectosigmoid area, the digital crushing procedure is recommended in the nursing manuals. To facilitate the breakdown of the fecal impaction, it is possible to practice enemas of glycerin and / or hot mineral oil (eg. Vaseline oil), asking the patient to hold it for 20-30 minutes before proceeding with the manual emptying or with the aid of a special spoon. This is obviously a nursing procedure, therefore carried out by expert personnel who know the patient's clinical history and the causes of fecaloma. The maneuver is, for example, contraindicated in the case of a patient who has recently undergone surgery or convalescing from trauma to the anus or rectum.Possible contraindications to the digital shattering of fecal impaction also concern the presence of active inflammatory intestinal pathologies and rectal pain or bleeding, the intake of anticoagulant drugs and the presence of important heart disease. Excessive manipulation of the rectum can in fact cause an important irritation of the mucosa of the same, up to bleeding, but also stimulate the vagus nerve, with possible reflex decrease in heart rate. however, this is an eventuality to be evaluated with due attention, since in the case of severe occlusion the use of osmotic laxatives can precipitate the patient's clinical picture (abdominal distension, cramps).
In terms of primary and secondary prevention (which takes place when a patient has already had a previous history of fecal impaction), it is of course essential to avoid constipation, regularizing the eating style (adequate intake of fiber and water, avoiding binges) and life in general (increased physical activity to stimulate intestinal motility). If the doctor deems it appropriate, the prevention of constipation can also take place through the intake of laxatives or the suspension of drugs that reduce intestinal motility. Chronic abuse of laxatives, which in addition to causing various types of complications (eg electrolyte imbalances), can even - causing intestinal atony with a reduction in peristalsis - be an important risk factor for the development of fecaloma.
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