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 fecal impaction. Research studies have shown that by the success of the PIE MED treatment prevented patient hospitalization for fecal impaction.Individuals who have had one fecal impaction are at high risk of future impactions. 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 fecal impactions; these conditions should be treated to reduce the risk of future impactions. Many types of medications (most notably opioid pain medications, such as codeine) reduce motility of the colon, increasing the likelihood of fecal impactions. 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.
Spinal cord injury is a common cause of constipation, due to ileus. Manual removal of a fecal impaction is often required with obese patients in traction, after a barium enema, and in poorly hydrated older adults. Prevention
Reducing opiate-based medication (when possible, tolerable, and safe; prescription medication changes should be done under the supervision of a physician), and adequate intake of liquids (water) and dietary fiber and daily exercise. Treatment
The treatment of fecal impaction requires both the remedy of the impaction and treatment to prevent recurrences. Decreased motility of the colon results in dry, hard stools that in the case of fecal impaction become compacted into a large, hard mass of stool that cannot be expelled from the rectum. Various methods of treatment attempt to remove the impaction 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 patients 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.