The treatment of<unk>  requires both the remedy of the<unk>  and treatment to prevent recurrences. Decreased motility of the colon results in dry, hard stools that in the case of<unk>  become compacted into a large, hard mass of stool that cannot be expelled from the rectum. Various methods of treatment attempt to remove the<unk>  by softening the stool, lubricating the stool, or breaking it into pieces small enough for removal. Enemas and osmotic laxatives can be used to soften the stool by increasing the water content until it is soft enough to be expelled. Osmotic laxatives such as magnesium citrate work within minutes - eight hours for onset of action, and even then they may not be sufficient to expel the stool. Osmotic laxatives can cause cramping and even severe pain as the patient's attempts to evacuate the contents of the rectum are blocked by the fecal mass. Polyethylene glycol (PEG 3350) may be used to increase the water content of the stool without cramping. This may take 24 to 48 hours for it to take effect, and it is not well suited to cases where the<unk>  needs to be removed immediately due to risk of complications or severe pain. Enemas (such as hyperosmotic saline) and suppositories (such as glycerine suppositories) work by increasing water content and stimulating peristalsis to aid in expulsion, and both work much more quickly than oral laxatives. Because enemas work in 2–15 minutes, they do not allow sufficient time for a large fecal mass to soften. Even if the enema is successful at dislodging the impacted stool, the impacted stool may remain too large to be expelled through the anal canal. Mineral oil enemas can assist by lubricating the stool for easier passage. In cases where enemas fail to remove the<unk> , polyethylene glycol can be used to attempt to soften the mass over 24–48 hours, or if immediate removal of the mass is needed, manual disimpaction may be used. Manual disimpaction may be performed by lubricating the anus and using one gloved finger with a scoop-like motion to break up the fecal mass. Most often manual disimpaction is performed without general anaesthesia, although sedation may be used. In more involved procedures, general anaesthesia may be used, although the use of general anaesthesia increases the risk of damage to the anal sphincter. If all other treatments fail, surgery may be necessary. An easier, more comfortable, and more efficient method to enema and manual disimpaction is to use pulsed irrigation evacuation (PIE). This method implemented with PIE MED allows for patients to rest in bed as the procedure takes place. By using pulsating water to enter into the colon to soften and break down the dense mass, PIE effectively treats<unk> . Research studies have shown that by the success of the PIE MED treatment prevented patient hospitalization for<unk> . Individuals who have had one<unk>  are at high risk of future<unk> s. Therefore, preventive treatment should be instituted in patients following the removal of the mass. Increasing dietary fiber, increasing fluid intake, exercising daily, and attempting regularly to defecate every morning after eating should be promoted in all patients. Often underlying medical conditions cause<unk> s; these conditions should be treated to reduce the risk of future<unk> s. Many types of medications (most notably opioid pain medications, such as codeine) reduce motility of the colon, increasing the likelihood of<unk> s. If possible, alternate medications should be prescribed that avoid the side effect of constipation. Given that all opioids can cause constipation, it is recommended that any patient placed on opioid pain medications be given medications to prevent constipation before it occurs. Daily medications can also be used to promote normal motility of the colon and soften stools. Daily use of laxatives or enemas should be avoided by most individuals as it can cause the loss of normal colon motility. However, for patients with chronic complications, daily medication under the direction of a physician may be needed. Polyethylene glycol 3350 can be taken daily to soften the stools without the significant risk of adverse effects that are common with other laxatives. In particular, stimulant laxatives should not be used frequently because they can cause dependence in which an individual loses normal colon function and is unable to defecate without taking a laxative. Frequent use of osmotic laxatives should be avoided as well as they can cause electrolyte imbalances.
Fecal impaction
Defecation
Rectal discharge
Vesicointestinal fistula
Fecal vomiting
Rectal douching
Rectal foreign body
Lactose intolerance