Page 212 - ATP-P 11th Ed

CONSTIPATION / FECAL IMPACTION PROTOCOL

SPECIAL CONSIDERATIONS
1. Differential diagnosis includes acute appendicitis, volvulus, ruptured diverticu-
lum, bowel obstruction, pancreatitis, or parasitic infections.
2. Acute onset, severe pain, point tenderness, and fever indicate etiologies other
than constipation or fecal impaction.
SECTION 2 Signs and Symptoms

1. Recent history of infrequent passage of hard, dry stools or straining during defecation.
2. Abdominal pain, which is typically poorly localized with cramping.
3. If pain becomes severe and is associated with nausea/vomiting and complete lack of
flatus or stools, consider a bowel obstruction.
Management
1. Perform digital rectal examination to check for fecal impaction. Often times this is the
only intervention necessary.
2. Bisacodyl (Dulcolax ) 10mg PO tid prn
®
3. Avoid narcotics as this will exacerbate the constipation.
4. For impacted stool or no relief with above measures, give normal saline enema 500mL
via lubricated IV tubing (patient should retain solution for 2 minutes before evacuating
contents).
5. If fecal impaction is still present, perform digital disimpaction, if trained.
6. Increase PO fluid intake.
7. Increase fiber (fruits, bran, and vegetables) in diet if possible.
8. If severe pain, rigid board-like abdomen, fever, and/or rebound tenderness develop, or
moderate to large amounts of blood are present in the stool, then treat per Abdominal
Pain Protocol.

Disposition
1. Evacuation is usually not required for this condition.
2. Routine evacuation if no response to therapy.

202 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 203