Ever had a fecal impaction.--“A hard mass of stool that got stuck in your rectum and you can’t push it out?”
An in-home approach that usually works
People begin to feel an urge to defecate when a hunk of feces slides from the sigmoid colon into the distal rectum.
When the stool gets close to the anal canal the sphincter tightens. It’s a reflex. The job of the anal sphincter is to keep stool in.
When someone starts to defecate, stool moves into the anal opening and a reflex causes the sphincter to relax.
an impaction starts when a sphincter doesn't loosen up and allow the stool to move into the anal canal.
In most cases the person who is impacted can solve the problem by fooling the anal sphincter. He or she puts on a disposable glove or shields the index finger with a thin plastic bag. Then they coat the finger with a layer of Vaseline gel.
Next, the person slides the index finger gently through the anal opening. They rotate the finger around the inner wall of the sphincter and slowly enlarge the aperture--gradually stretch the sphincter muscle open.
The muscle will sense stool moving through the canal and It is programmed to let feces pass, so the sphincter will usually relax some. sometimes you need to spread the muscle a few times and bear down. The trick isn’t always successful and may not work in a bedridden hospitalized patient, but as a home remedy it’s pretty good.
Technically holding your breath, then straining and 'pushing downwards' with the diaphragm is called the Valsalva maneuver thanks to the Italian physician, Antonio Maria Valsalva (1666-1723).
Disclaimers on the internet warn people that the increased pressure in the thoracic cavity reduces the amount of blood flowing into the thoracic cavity and “can cause blood clots to detach, bleeding, irregular heart rhythms and cardiac arrest.”
https://www.toilet-related-ailments.com/valsalva-maneuver.html
WebMD’s website suggested “an enema...fluid that your “doctor” inserts into your rectum to soften your stool… If it doesn’t do the trick “the stool must be broken up and removed by hand.”
In reality the nurse is usually the person who gives the enema, and I don’t know who, nowadays, inserts their index finger and divides the stool into smaller chunks.
When a hospitalized, bed ridden person becomes impacted there’s usually no need to call a specialist, but I remember a day (and this is a true story) when an unnamed gastroenterologist I know was called. He evaluated the patient, felt the problem was an impaction, and told the nurse to give the patient an enema.
When the liquid didn’t solve the problem, the consultant thought the nurse should manually dis-impact the patient. The procedure is painful and low tech. When it is performed on a sick, bedridden, somewhat out-of-it, individual, people down the hall are sometimes “entertained” by series of loud, blood curdling screams.
In this instance the nurse thought the doctor’s order was demeaning. She was near the end of her shift and she deferred the dis-impaction to the incoming nurse. The new nurse felt that the prior nurse’s “shirk” was humiliating and degrading. She managed to be overwhelmingly busy during her shift and she, too, passed the task to the next care giver.
On occasion the problem can be caused by a narcotic medication.
LAXATIVES
There are basically three types of laxatives
Type one: Saline laxatives that suck liquids into the small intestines. The fluid then flows downstream and washes out the small and large bowel.
This category includes magnesium based compounds like milk of magnesia, and magnesium citrate.
And pharmaceutical creations that contain polyethelene glycol, products like miraLAX”.
Type two: portions of poorly absorbed fruits and vegetables,
Wheat bran, the fiber rich hard outer layer of the wheat kernel; and Metamucil, a pharmaceutical product whose chief ingredient is the hulk of psyllium seeds.
Type three: colonic stimulants
Senna compounds and Biascodyl –Dulcolax. These products irritate the inner wall of the colon. They do something to enteric neurons and cause the bowel muscles to contract. By so doing they stimulate peristalsis and cause the colon to evacuate its contents.
I have seen a number of patients who take senna regularly. Once they started the laxative and continued to take it for a while they were “hooked”, and were unable to empty their bowels without the medication.
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