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Stool Softeners (emollient laxatives)

Active Ingredients: Docusate Sodium, Docusate Calcium

Popular Brands: Dulcolax, Colace, etc.

How they work: A laxative is a medication that helps relieve constipation by attempting to move your stools in some way. One popular type of laxative is the stool softener. It works by increasing the amount of water your stool absorbs in your intestine, making it softer.

How is it used: Stool softeners come in oral forms (tablets, softgels, liquid syrups) and rectal suppositories

Pros: Usually starts working within 12-72 hours.

Cons: They are only helpful for mild constipation and are contraindicated for bowel obstructions and fecal impactions. They can also cause rectal bleeding and irritation around the rectum. Of all the treatment options listed here, these have the lowest overall effectiveness.

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Bulk-Forming Laxatives

Active Ingredients: Psyllium, methylcellulose, calcium polycarbophil, bran, dextrin

Popular Brands: MetaMucil, Citrucel, FiberCon

How they work: When taken with water, the powder forms a thick gel that creates bulk stool. This gelatinous bulk is supposed to stimulate your gut to push the stool along and help you have a bowel movement.

How is it used: Available as tablets/capsules or taken as a powder mixed with water.

Pros: Substances like psyllium have prebiotic properties and can be safely used for a longer period compared to stool softeners. Studies have also shown that it can be beneficial for the heart.

Cons: These products are not made for fecal impaction and can worsen your condition by adding more bulk to your already wedged stool. This can increase your colonic and rectal load, further increasing your chances of a perforation. Never take these products without first talking to your doctor.

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Stimulant Laxatives

Active Ingredients: Bisacodyl, sennosides, castor oil

Popular Brands: Senokot, Exlax

How they work: The active ingredients in these products have two effects on your digestive tract – it causes your gut muscles to contract and water to be released into the intestine. The combined effect is the stimulation of a bowel movement.

How is it used: Tablets or liquid

Pros: They tend to work within 6-12 hours.

Cons: Use of stimulant laxatives has shown to promote fecal impaction in the long run because they lower your intestinal nerve response to the presence of stools. This means you will need to increasingly rely on them to have a bowel movement until they eventually lose their effectiveness and your fecal impactions becomes worse.

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Lubricant Laxatives

Active Ingredients: Mineral oil

Popular Brands: Kondremul

How they work: The oil coats your stools and your digestive tract. This not only prevents your stool from losing water and becoming drier, it also lubricates the movement of the fecal mass through your colon.

How is it used: The oil is either taken orally or as an enema

Pros: They are good for short term relief of mild constipation

Cons: Lubricant laxatives can cause delayed healing of injuries to your digestive tract from a fecal impaction. Since the oil is not absorbed by your digestive tract, it can cause embarrassing rectal leakages. Just like stimulant laxatives, they can cause dependence and long-term use is not recommended because they can interfere with your body’s absorption of vital fat-soluble vitamins (A, D, E and K).

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Hyperosmotic Laxatives

Active Ingredients: Glycerin, polyethylene glycol (PEG), sorbitol, lactulose

Popular Brands: MiraLax

How they work: These laxatives work by increasing the flow of water into the intestines, softening your stool and making it easier to pass.

How is it used: Can be taken orally as a powder mixed with water or rectally as suppositories/enemas (glycerin).

Pros: They are helpful for chronic constipation and safer than stimulant laxatives because they can be taken for a slightly longer period.

Cons: While these products, especially PEG 3350, are commonly used to treat fecal impactions, product literature specifically contraindicates their use for intestinal obstructions because they can increase your chances of developing a perforation.

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Saline Laxatives

Active Ingredients: Magnesium citrate, magnesium hydroxide

Popular Brands: Phillips

How they work: These products work on the same principle as hyperosmotic laxatives by using salts that draw water into the digestive tract and stimulating stool movement.

How is it used: Usually taken orally in liquid form

Pros: Unlike bulk-forming laxatives that hold water in the form of a gelatinous substance, these products actually increase the water content of your intestine which can promote a bowel movement.

Cons: Not only is this type of laxative not recommended for people with bowel obstructions or colitis (common in fecal impaction sufferers), it is also prone to causing dependency and a progressive slowdown of your digestive tract with prolonged use. Saline laxatives are also known to cause electrolyte imbalances and can even damage your kidneys.

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Water Enema / Saline Enema

Also known as: Bowel irrigation, anal irrigation, rectal irrigation, colonic irrigation

This method uses: Normal water or salt water and an enema kit. Some methods also call for adding castile soap to the solution to act as an irritant that stimulates gut muscle contractions.

How it works: An enema setup uses a bag that is filled with normal warm water, with or without saline, connected to a catheter via a tube. The catheter is inserted carefully into the rectum and water is slowly pumped into the rectal canal either by squeezing the water bag or a pump. Once your rectum is filled with the enema solution, it stretches the digestive tract and triggers peristaltic movements which should help move any stuck stool move out of your body.

Pros: Usually works within minutes and is helpful for occasional constipation.

Cons: Enemas should never be attempted during fecal impaction because it can lead to a life-threatening bowel rupture. In fact, research shows that perforations caused by enemas at home have a much higher mortality rate than perforations that occur while hospitalized.

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Epsom Salt Enema

Also known as: Magnesium sulfate enemas

This method uses: Similar to a water enema, this setup uses a bag or a squeeze bottle connected to a catheter which is used to introduce the solution into the rectum.

How it works: Epsom salt enemas work similar to saline enemas except their high magnesium content is believed to be more effective in relaxing the gut muscles and easing your constipation.

Pros: It is said to be more effective than a water enema in its purging effects.

Cons: Many health professionals do not recommend Epsom salt enemas because it can easily cause magnesium poisoning. In fact, even a single enema contains enough elemental magnesium to cause fatal toxicity in the user.

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Sodium Phosphate Enema

This method uses: Sodium phosphate enemas typically come as pre-prepared solutions in small squeeze bottles with soft tips meant to be inserted into the rectum to dispense the liquid contents.

How it works: These enemas work similar to hyperosmotic laxatives by drawing water into the intestine. The increased fluid content of the rectum causes it to distend, which in-turn stimulates gut motility.

Pros: Comes pre-prepared in a convenient bottle with easy to follow instructions.

Cons: Fecal impaction sufferers should avoid sodium phosphate enemas because their impaired gut can prolong the absorption of phosphate into the body and can lead to acute kidney injury and even renal failure.

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Glycerin Enema/Glycerin Suppositories

This method uses: This product typically comes pre-packaged in a small balloon-shaped bottle with a soft insert tip used to squeeze the glycerin solution into the rectal canal.

How it works: Glycerin enemas and suppositories work by increasing the water content of your rectum which stimulates peristalsis and triggers bowel movements.

Pros: Glycerin itself is a safe compound that doesn’t have toxic effects or overdose issues.

Cons: It is just as dangerous as a water enema during a fecal impaction because it can further add to your already critically high rectal lumen pressures and increase your risk of a dangerous perforation. This risk exists whether you use an enema or a suppository because both increase the water content of your intestine.

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Mineral Oil Enema

This method uses: Comes pre-prepared in squeeze bottles with soft tips.

How it works: Using mineral oil as an enema is meant to coat your stool in a water-proof film to prevent it from getting drier and to lubricate your intestine to ease the stool’s movement through it.

Pros: Considered safer than sodium phosphate and Epsom salt enemas.

Cons: In addition to having the same risks as water enemas mentioned above, mineral oil enemas attempt to prevent the problem after it’s already occurred. For example, the stool mass of fecal impaction sufferers is already too dry for the mineral oil to be able to prevent any further stool water loss. Similarly, the fecal mass of during an impaction is already so large that lubricants rarely work to get it moving again.

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Increasing fiber in your diet

Reasoning for this advice: By increasing your dietary fiber, especially insoluble fiber, you are able to increase your stool bulk and water retaining ability of your colon, both of which should result in stools that are less dry and easier to excrete.

What the research says: Though this advice is commonly believed, recent evidence suggests that low dietary fiber does not necessarily lead to constipation. In fact, research shows that people with chronic constipation have similar fiber intake compared to controls.

Pros: Bowel health aside, eating a fiber-rich diet has shown to lower cholesterol levels, help control blood sugar levels and maintain a healthy weight.

Cons: Clinical evidence now indicates that increasing dietary fiber in patients with chronic constipation can actually worsen symptoms. Increasing fiber intake can be even worse for fecal impaction sufferers because it can further increase your fecal load and increase your chances of a perforation.

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Increasing your water intake

Reasoning for this advice: It is commonly recommended that constipation sufferers avoid dehydration and drink about 6-8 glasses of water per day. It is believed that normal hydration should lead to a higher water content in stools and more frequent bowel movements.

What the research says: Unfortunately, studies dispute this common belief. Research shows that increasing oral fluids has little to no effect on chronic constipation.

Pros: Though it may not help you with your constipation, drinking water can be help aid your digestive function, brain function and kidney function.

Cons: While staying adequately hydrated is important, drinking too much water can worsen some of your fecal impaction symptoms such as bloating and abdominal pain.

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Increasing your physical activity

Reasoning for this advice: Population data shows that physically fit people do tend to have lower incidences of constipation. So, it is believed that increasing your physical activity may have a preventative effect on mild constipation.

What the research says: Studies show that when it comes to your intestinal function, exercise has no effect on your fecal mass or stool frequency.

Pros: Regardless of its lack of effectiveness when it comes to chronic constipation or fecal impaction, regular exercise can help you control your weight and combat many different diseases..

Cons: Though exercise itself does not carry any harm for fecal impaction sufferers, research indicates that it is likely to not be helpful in treating it.

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Manual Disimpaction / Digital Disimpaction

Also known as: Digital defragmentation, digital extraction, digital evacuation

How it works: This method is used by doctors to manually break up a hard stool mass stuck in the rectum. To do this, the doctor first lubricates the anus with a gloved finger, then scooping motions are used to remove feces.

Pros: Helpful for immediate removal of impacted fecal matter in the rectal canal, especially in cases where the pelvic floor or anorectal muscles and nerves are dysfunctional.

Cons: Digital disimpaction should only be done by a trained health professional because it carries the risk of damage to the internal anal sphincter and can also lead to a fatal perforation.

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Pelvic Manipulation / Abdominal Manipulation / Perineal Massaging / Vaginal Splinting

How it works: Unlike manual disimpaction where the stool has to be broken by directly defragmenting it with a finger, these methods use a massaging technique to feel for the fecal mass outside the body and gently manipulating it so that it gets unstuck and starts moving again.

The goal here is to soften the fecal mass and use a rhythmic motion to match your natural peristaltic movements and stimulate a bowel movement. Depending on where your fecal mass is stuck, the massage can be performed at different locations including the abdomen (abdominal manipulation), vaginally (vaginal splinting) or close to the anus (perineal massaging).

Pros: Can be combined with other treatment methods to increase their effectiveness.

Cons: This technique should only be performed by a medical practitioner when it comes to fecal impactions because of an increased risk of developing a perforation. The fecal mass is not always readily palpable upon a physical exam.

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Endoscopic Disimpaction

How it works: This method is reserved for cases that don’t respond to other treatments mentioned above, also known as refractory fecal impaction. During this procedure the doctor inserts an endoscope with a guidewire loop at the tip and slowly breaks away the hard stool mass for extraction.

Pros: Far less invasive than conventional surgery to treat a fecal impaction.

Cons: This procedure needs to be carried out in a clinical setting and carries the risk of perforation.

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Colon Resection Surgery / Colostomy

How it works: When your fecal impaction becomes so severe that it either causes a tear in the digestive wall or a dangerous infection (peritonitis), immediate surgery becomes absolutely necessary. During surgery, the doctor attempts to remove all fecal contamination from your abdominal cavity and cut out any necrotic digestive tissue.

The surgeon can either remove a portion of your colon and reattach the two adjoining ends or create an artificial opening in your abdominal wall so that your stools can bypass the remaining damaged part of the colon and empty into a colostomy bag.

Pros: If you develop a perforation, immediate surgery can save your life.

Cons: Even after surgery is performed, the mortality rate for a colon perforation is very high. That’s why it is crucial to not just prevent your condition from ever getting to this point, if you do end up noticing signs of peritonitis or a rupture, you should get to a hospital right away.