Q. What would be the appropriate thing to do? Select Appropriate or Not appropriate for each of the questions below.
Q. What would be the Appropriate thing to do?
1) Administer Suppositories/ micro enema – Appropriate – Administering suppositories/micro enema will help to relieve possible discomfort if stool in rectum. A PR examination would determine rectal stool consistency. NB: ensure suppository inserted between anal wall and stool, not into stool as this would have no effect.
2) Do nothing and monitor – Not appropriate – Doing nothing and monitoring will not resolves Roberts’ faecal impaction.
3) Stop Fybogel™ – Appropriate – Stopping fybogel™ is appropriate because it is a bulking agent. Stopping all laxatives would be Inappropriate thing to do, as this will make the problem worse. This is a common mistake as overflow maybe mistaken for diarrhoea and laxatives are stopped rather than increased or changed to something more appropriate.
4) Change laxatives – Appropriate – Change oral laxative – the patient is currently on fybogel™ which will make constipation worse if fluid intake is inadequate. Stop fybogel™ and prescribe high dose macrogol.
5) Consider abdominal x-ray –Appropriate – Consider abdominal x-ray to assess for impaction and obstruction. Liaise with medical staff.
6) Abdominal Examination – Appropriate – An abdominal examination is performed to assess for faecal loading and impaction.
7) Consider PR exam -Appropriate – A PR exam is used to assess for presence of stool in rectum, amount, type and consistency.
8) Manual evacuation – Not appropriate- Manual evacuation should be used only when impacted rectum causing distress and if laxatives and rectal preparations unsuccessful.
9) Administer enema (e.g. phosphate) –Appropriate– Administering a high volume stimulant enema is a 1st option after a PR examination to determine stool consistency in rectum.
Page last reviewed: 31 Jan 2022
