Fecal blockage symptoms. Fecal stone (Intestinal stone, Coprolite)

anonymously

Hello! We no longer know who to turn to. Therapists don't say anything. My grandmother is 82 years old, has been suffering from constipation for 5 years, if not more. Immediately began to drink all sorts of herbal laxatives, like senna. Now they are no longer helping. Takes Bisacodyl tablets and suppositories, tried Sinade, Prelaks. Prelaks used to help, the last time - no. An enema also does not work - an elderly person does not withstand the required amount of time. She has been sick for 1.5 months. They cannot make an exact diagnosis - either kidney stones, or osteochondrosis. We keep on injections: Ketonal, Noshpa and similar drugs. Virtually no help. Now he complains not about his back, but about his leg and lower abdomen. Now we think it could all be from the gut. Today, as the ambulance called us, she had a fecal blockage. Barely cleared, but by how much - it is not clear. What can be done now? How can an elderly, powerless person do an enema so that it really cleanses, and does not immediately pour out? Are there any devices that supply water under low pressure so that it flows deeper? What should be the diet to make it easier for her to toilet? What products complicate it and strengthen it? What preparations are better to accept that there was no again "fecal obstruction"? Can MCC help?

Given their age, helping is difficult. You need to eat vegetable fiber, so that the intestines contract, drink fresh kefir. You need to massage the abdomen and move. Does she move around the apartment, go out into the street? If there is no stool for a day, then you need to call it: suppositories with hycerin, dufalac, normase. hepatologist Stepanova T.V.

Complications of chronic constipation

Long-term constipation can cause various complications: secondary colitis, proctosigmoiditis (inflammation of the sigmoid and rectum).

With prolonged stagnation of the contents in the caecum, it may be thrown back into the small intestine with the development of enteritis (reflux enteritis). Constipation can be complicated by diseases of the biliary tract, hepatitis.

Prolonged constipation contributes to the appearance of various diseases of the rectum. Most often, hemorrhoids occur, as well as rectal fissures, inflammation of the perirectal tissue (paraproctitis).

Sometimes they cause the colon to expand and lengthen (acquired megacolon), which makes constipation even more stubborn.

The most formidable complication of prolonged constipation is cancer of the rectum and colon. There is an opinion that the stagnation of contents in the intestine, caused by the use of foods poor in dietary fiber, leads to a large concentration of carcinogenic (cancer-promoting) substances formed in the intestine and their long-term effect on the intestinal wall. Alarming symptoms that make it possible to suspect the possibility of a tumor of the colon are general poor health, weight loss, the recent appearance of constipation in people over 50 years old, whose stools were normal before, blood in the stool.

fecal blockage

Finally, about such a very unpleasant phenomenon as a fecal blockage. This condition occurs quite frequently in the elderly and in the mentally ill. This complication of constipation occurs when older people, especially those who are poorly groomed, forget the time of the last bowel movement and stop monitoring its regularity. The matter is complicated by the fact that around the fecal stone formed and gradually compacted in the rectum, there are long gaps between it and the walls of the intestine, through which liquid feces pass; the patient imagines that he has diarrhea, and he begins to treat it with home remedies, which, of course, only aggravates the process. Partial obstruction of the rectum sets in, abdominal pains appear, appetite disappears, belching, nausea, and vomiting appear. When examining such patients with a finger, the lower pole of the fecal lump of stony density is usually reached. Usually in this case, the elderly patient has concomitant heart or lung failure or other serious health disorders, so that the treatment of fecal blockage is difficult. First of all - no laxatives; they must be used earlier, and in the described condition they can only lead to an increase in intestinal obstruction. Enemas will also not help: the enema tip usually cannot freely penetrate above the stone, they cannot be blindly used to crush the stone because of the risk of injury to the intestinal wall. It is necessary with a hand and a thick rubber glove, having well lubricated the index finger with ointment, to begin careful and gradual crushing of the distal part of the stone, removing its freed fragments. The position of the patient on his side (preferably on the left, if there are no severe cardiac disorders) with knees bent and legs pressed to the stomach. Usually this manipulation is possible without much difficulty, because, as a rule, in such patients, the tone of the anal sphincter is lower and the anus almost gapes. Nevertheless, this procedure is lengthy and, to put it mildly, uncomfortable for the patient, therefore, in such cases, sedatives or painkillers are preliminarily prescribed. When the most dense distal sections of the stone are crushed, the rest, its upper parts are removed much more easily and at the end either an independent, very abundant bowel movement begins, or a siphon enema should be performed. Having resolved the fecal blockage, the patient or his relatives are explained measures to prevent stool retention (weekly cleansing enemas are best), because if you limit yourself to only extracting fecal stone (stones), then everything will start all over again.

Abdominal pain and appetite disorders do not always indicate an inflammatory process in the digestive organs. If at the same time there is a tendency to constipation, then fecal stones (coprolites) may have formed in the intestines. Despite the fact that they may not show signs of presence for a long time, increasing in size, they can cause serious harm to health. What are fecal stones and how to treat them? About this in the article.

What is a fecal stone

Fecal stones in the intestines (see photo) are dense formations that form in the lumen of the lower intestine due to some adverse factors. They are oval or spherical in shape. The size reaches 15 cm in diameter; rare formations of large sizes.

The composition of fecal stone in various ratios may include:

• mineral salts (calcium carbonate, magnesium oxalate or phosphate);
• refractory fats;
• bacteria;
• bile acids and other organic substances.

Pathology is more typical for people of age, but it can also occur in young people, as well as children. It is most widespread in the northern regions, in which the diet contains little fiber, but a lot of fat. The disease is equally inherent in both men and women.

The mechanism of occurrence and types

Coprolites can be single or formed in large numbers. According to etiology, they are true, the formation of which occurs in the large intestine, and false, which have entered the intestine from the gallbladder or bladder. The latter can act as a basis for the formation of a true coprolite.

Causes

There are different groups of reasons that contribute to the formation of stones in the feces in an adult.

• age factor. The disease occurs with atrophy of the muscular layer of the intestine and the resulting hypotension and/or atony. Often this disorder occurs in older people.
• Diseases. Some acquired and congenital diseases, such as intestinal diverticula, Parkinson's disease, Hirschsprung's disease and others, lead to a violation of the motor function of the organ and / or an increase in the length of the intestine. This causes stagnation of feces and the formation of fecal stones.
• Foreign bodies. Fruit bones, small remains of animal bones, undigested pieces of food can provoke the formation of coprolites, acting as a base.
• Inflammatory bowel disease. Diseases in which there is a profuse secretion of mucus or bleeding can also cause the formation of fecal stones. In addition, the inflammatory process can change the chemical composition of the feces.
• Diet. With the abuse of foods containing a lot of calcium or refractory fats, the likelihood of the formation of coprolites increases significantly.
• Taking medication. Antibacterial and painkillers can provoke the formation of fecal stones.
• Wrong drinking regime. The lack of fluid in the body leads to increased absorption of water from the feces, contributing to their hardening and the occurrence of frequent constipation and coprolites.

Other factors that can cause fecal stones in the intestines include lack of physical activity, alcohol abuse, overeating, and increased sensitivity to stress.

Symptoms of fecal stones

The disease may not manifest itself for the time being. It happens that formations are detected randomly during the examination. In other cases, the following symptoms of fecal stones in the intestine can be distinguished:

• constipation;
• abdominal pain (if the stone is large, it can damage or irritate the intestinal wall);
• an admixture of mucus or blood in the feces;
• alternation of constipation with loose stools - (occurs due to the flow of stone and solid feces with more liquid masses);
• bloating.

Fecal stones manifest themselves as constipation and abdominal pain

Attention! Due to chronic intoxication of the body, patients also observe such symptoms of fecal stones as: problems with appetite, weakness, periodic nausea, irritability.

Diagnosis of the disease

Before getting rid of fecal stones in the intestines, a differential diagnosis is mandatory. It is necessary to distinguish between the symptoms of coprolites with similar ones in other diseases:

• colon tumors;
• haemorrhoids;

The following methods are used for diagnosis.

• Palpation. During the examination by digital rectal method, the proctologist detects a dense formation that can leave marks on the glove.
• Sigmoidoscopy. This method allows you to diagnose fecal stones located in the lower intestines. It is carried out using a sigmoidoscope - a special device equipped with an air supply system, illumination of the intestinal lumen and an eyepiece for visualizing the inner walls.
• Irrigoscopy. This is an x-ray method based on the introduction of a contrast agent into the intestine. Unfortunately, in most cases, it does not allow to distinguish coprolite from tumor formations or a polyp.
• . This diagnostic method is based on the examination of the internal state of the intestine by using an endoscope. The procedure is similar to sigmoidoscopy, but unlike it, it makes it possible to examine the entire large intestine (almost 1.5 m). If necessary, during colonoscopy, it is possible to take material for subsequent histological analysis.

In some cases, when none of the above methods helped, it is possible to use the method of diagnostic laparoscopy. Biochemical and general blood tests in the diagnosis of coprolites are of additional importance.

Treatment

Treatment of fecal stones is carried out mainly by conservative methods. With their ineffectiveness or damage to the intestinal wall by the proctolitis, or the occurrence of intestinal obstruction, an operative approach is used.

Conservative treatment with enemas

A conservative approach suggests bowel cleansing with enemas and medications as a treatment for proctolitis.

• Siphon enema. It is carried out using a sufficiently large volume of water - about 12 liters. after emptying the intestines, it is filled again.
• Cleansing enema. It is used in the presence of not too large proctolites in the intestinal lumen. The volume of injected fluid is about 1.5 liters.
• Hydrocolonotherapy. This procedure is carried out after it was not possible to remove fecal stones from the intestines by other methods. It requires the use of special equipment. Its duration is about half an hour, during which the doctor monitors the patient's condition on the monitor. The volume of injected fluid is 20-30 liters.

Use of laxatives

Laxatives are the most gentle treatment for fecal stones. They are presented in a wide variety in different forms: medicines, tablets, candles and others.

Important! It must be remembered that laxatives have different mechanisms of action. Therefore, only a doctor should choose a drug suitable for a particular patient.

In addition, most laxatives reduce the amount of potassium in the body. This should be remembered by people with heart failure.

A problem like fecal plug in the intestinal cavity is quite common. At the same time, the development of pathology does not depend on the age and social status of a person. However, there are factors that increase and decrease the likelihood of the formation of this disease, which everyone should be aware of.

Chronic and periodic, but prolonged, constipation, with improper treatment, often results in various complications, including fecal plug. This pathology is characterized by the formation of seals in the gastrointestinal tract, which block the lumen of the colon, thereby disrupting the natural exit of processed waste products.

Cork sizes vary from three centimeters or more, and its shape can be either round or oval. It consists of dense solid feces, blood clots, hair and unprocessed plant fibers. Also, cork often contains high levels of magnesium carbonate and other compounds that indicate the abuse of junk food.

The content of a fecal plug depends on the underlying problem that led to its formation. So, if the cause of bad stools is a dysfunction of the stomach or pancreas, then undigested pieces of food and medicines may be in the cork. If there is a problem with the gallbladder, then gallstones can be observed in the accumulated stool.

To figure it out how to remove fecal plug without causing harm to health, it is necessary to seek advice from a proctologist. Self-medication can end in failure, since a too dense cork or the formation of several stones at once can break the intestinal walls, which will provoke internal bleeding.

Factors affecting the development of cork

In medical practice, problems with the rectum in the form of fecal plugs are very common. The main reason for the appearance of fecal stones in the intestinal lumen is constipation. Fecal plug especially actively formed in chronic problems with defecation, which are of a long-term nature.

The causes of such constipation, and, accordingly, traffic jams, may be:

• low physical activity;
• constant overeating;
• the presence of smoked meats in the diet;
• abuse of fried and fatty foods;
• colon deformity;
• poor work of peristalsis;
• hormonal imbalance, etc.

Also, the presence of hemorrhoids and anal fissures can push the appearance of a fecal plug. Often, due to such problems, a person restrains the urge to defecate, which leads to aggravation of constipation and the complications associated with it.

In addition, the cause of the development of this pathology may be the presence of kidney stones, an inflammatory process in the intestines and typhoid fever.

Symptoms of the disease

The presence of dense formations in the gastrointestinal tract cannot go unnoticed. The patient has paroxysmal, which later become permanent, and a complete absence of stool. The urge to defecate brings nothing but increased pain and nausea.

A small plug in the intestinal lumen is manifested by the following symptoms:

• complete absence of bowel movements for more than three days;
• intestinal obstruction;
• flatulence;
• hardness and soreness of the abdomen;
• headache;
• malaise and weakness.

If the plug has reached a large size or there are several stones in the intestinal tract, then the symptoms are supplemented by unbearable cutting pains and intestinal bleeding. In this case, you cannot get rid of the formations on your own. The presence of such signs requires immediate hospitalization.

If we talk about newborns and children under three years old, then fecal plug in a child manifested primarily by the absence of stool and restless behavior. If the baby has never emptied himself during the day, and his tummy is hard and painful, then parents should be wary.

How to get rid of a fecal plug

What to do if in the intestinal lumen formed fecal plug how to get rid of at home from it, without causing even more harm to health? Cleansing the colon from blockages is best done under medical supervision. Before carrying out any procedures, it is necessary to undergo an examination by a proctologist to establish the stage of the disease. This is especially true for those traffic jams that appeared as a result of prolonged constipation (more than a week).

To remove fecal stones from the intestines, they must first be softened. To do this, resort to the enema procedure using vaseline oil, glycerin and hydrogen peroxide. Conventional solutions that do not contain oils will not work to soften and split blockages.

To improve the effectiveness of the procedure, in addition to an enema, they are prescribed that affect the work of peristalsis. But before you drink laxatives, you need to make sure that the stones soften under the influence of oils. If this does not happen, then the activation of peristalsis can provoke a rupture of the lower intestine. Therefore, therapy is always carried out under the supervision of doctors.

If not running fecal plug how to get rid of on one's own? Regardless of the stage of the disease, its treatment consists in splitting the accumulated feces. For self-cleansing of the intestinal lumen, a softening enema and laxatives are also used.

Surgical removal of fecal stones

How to remove a fecal plug with constipation lasting a week or more? Such blockages cannot be treated on their own, as they pose a danger to health and life in general.

Surgical treatment of fecal stones has the following advantages:

• complete cleansing of the intestines from stones;
• removal of accumulated mucus;
• improving bowel function;
• restoration of the normal shape of the colon.

Colon hydrotherapy is used to soften and remove feces. The procedure is as follows: a solution is introduced into the rectal cavity through a special tube and the intestines are washed for half an hour.

Surgical removal of fecal stones is resorted to at an advanced stage of the disease, when the pathological formation has led to complete intestinal obstruction. If there is no stool for more than 7 days, and periodic pains become constant, you should immediately consult a doctor.

Prevention of pathology

In order not to arise fecal plug what to do at home? The best prevention for blockages is and physical activity. Since the main cause of congestion is constipation, it is possible to prevent the disease only by achieving normal functioning of the gastrointestinal tract.

For a full-fledged daily stool, you must follow these recommendations:

• drink enough plain water (tea, coffee and other drinks do not count);
• include in the diet more fresh vegetables and fruits that improve the functioning of peristalsis;
• avoid fried, smoked, fatty and spicy foods;
• give up carbonated drinks and whole milk;
• introduce dairy products into the diet;
• do not get carried away with persimmons (it has been proven that this fruit affects the formation of fecal blockages).

If, nevertheless, there was a small fecal plug how to soften? With constipation in 3-4 days, boiled beets, dried apricots, prunes and oils (pumpkin, linseed, olive, etc.) should be included in the diet. These products perfectly soften the accumulated feces and activate the peristalsis, which guarantees daily emptying.

Many medical professionals do not pay due attention to this problem, especially in chronically ill and elderly people, considering this state of affairs to be quite natural, almost the norm. In fact, a violation of the excretory function of the intestine significantly worsens the patient's condition, his quality of life, leads to great complications. This is especially true for cancer patients, in whom constipation can be complicated by acute intestinal obstruction, which is not always possible to eliminate even surgically.

They call it constipation chronic delay in bowel movements (from the rectum or from a colostomy *) for more than 48 hours, which is accompanied by difficulty in the act of defecation, tension, pain and separation of a small amount of feces, increased hardness. (A.V. Frolkis, 1991; A.L. Grebenev, L.P. Myagkova, 1994).

WHAT IS CONSTIPATION?

Constipation – this is a consequence of a violation of the processes of formation of feces and their movement through the intestines.
Chronic constipation can be not only a sign of diseases of the colon and anorectal region, but also a manifestation of a number of extraintestinal diseases.
In the practice of a family doctor and a family nurse, the following types of constipation may occur:
- due to improper, malnutrition, lack of vegetable fiber in food, the use of refined foods that are completely soluble in water.

TYPES OF CONSTIPATION

♦ Neurogenic constipation associated with dysregulation of intestinal motility in duodenal ulcer, nephrolithiasis, cholelithiasis, diseases of the genital area. Neurogenic constipation occurs with multiple sclerosis, cerebrovascular accident, with tumors of the brain and spinal cord.
♦Psychogenic constipation it happens, if necessary, to perform an act of defecation in an unusual environment, in a lying position, on a ship. This type of constipation can be observed in mental illness, drug addiction.
♦Proctogenic constipation- can be with diseases of the anorectal region and rectum (hemorrhoids, anal fissures, cryptitis, paraproctitis).
♦ functional constipation with irritable bowel syndrome - due to hypertonicity (spasm) of the sphincters of the colon, especially - its distal sections.
♦ toxic constipation occurs with chronic poisoning with thallium, mercury, lead; against the background of long-term use of narcotic analgesics (codeine), diuretics (trifas, furasemide), antispasmodics (baralgin, No-shpa), etc.
♦Constipation in endocrine diseases- myxedema (slowdown of intestinal motility), diabetes mellitus (dehydration), pheochromocytoma, menopause, etc.
♦ "senile constipation" in the elderly, it is associated with hypodynamia, weakening of voluntary muscles, intestinal atony, endocrine disorders, mental inferiority.
♦ Constipation associated with an abnormal development of the colon- with Hirschsprung's disease, elongated sigmoid colon (megacolon), etc.
♦ Constipation as a manifestation of irritable bowel syndrome (IBS).
(A.V. Frolkis, 1979; N.D. Opanasyuk, 2002).

The disease of civilization, or why is it dangerous?

Constipation causes painful sensations due to intoxication. Patients suffering from constipation complain of rapid fatigue from their usual work, bad taste and smell from the mouth, loss of appetite, nausea, and bloating. Non-gastroenterological manifestations often significantly reduce the quality of life of patients: migraine-like headache, sensation of a coma in the throat when swallowing, dissatisfaction with inhalation, inability to sleep on the left side, chilliness of the hands, frequent urination, sleep disturbance. With chronic constipation, the skin becomes unhealthy, yellowish with a brownish tint, and turgor decreases. The tongue is covered with a dirty-looking coating.

With frequent and prolonged use of laxatives, signs of dehydration and hypovitaminosis are observed.
Lingering in the rectum, the feces gradually thicken and during defecation injure the mucous membrane of the anal canal. Anal fissures, ulcers, hemorrhoids are common complications of chronic constipation.
With constipation, “sheep” feces, “pencil” stools, “cork-like” stools can be noted, characterized by the release of dense, shaped feces at the beginning of defecation, and later - mushy and even watery feces.
With IBS, a fairly frequent complaint is the excretion of mucus with feces. The problem of constipation exists in 50% of hospitalized patients with generalized forms of cancer and 75-80% of patients observed at home (T. Orlova, 2008). Namely, patients observed at home, including oncological ones, deliver certain troubles to the family doctor and family nurse.

CAUSES OF CONSTIPATION

The causes of constipation in cancer patients are largely similar to those listed above, although they are associated with the presence of a local tumor. It:
♦ The presence in any part of the intestine of a tumor formation or adhesions that mechanically prevent the movement of feces.
♦ Immobility of the patient due to neurological disorders (paralysis), lymphostasis of the lower extremities, general weakness, cancer cachexia.
♦ Taking painkillers that depress intestinal motility (tramal, codeine, opiates, antispasmodics, antidepressants, antipsychotics, etc.).
♦ Violation of the psycho-emotional sphere - depression.
♦ Diseases of the perineum, etc.
The motor activity of the intestine has its own physiological characteristics, which should be taken into account in the prevention and treatment of constipation. Peristaltic contractions of the intestine normally have a pendulum type of movement, which contributes to better mixing of food, better contact with intestinal bacteria and digestion. Five to six times a day, a wave of longitudinal contractions occurs in the intestine, moving its contents to the exit. One of the strongest peristaltic waves occurs in the morning, the other at lunchtime. Knowing this, these periods should be used to put the patient on a ship or bedside chair, use rectal suppositories and enemas, and manually evacuate feces from the rectum.

A certain delicacy is required from the family nurse and, at the same time, sufficient certainty in clarifying some important issues, such as:
♦ What does the patient mean by “constipation”?
♦ Was there a tendency to constipation prior to the present illness?
♦ When was the last time you had a chair?
♦ What was the nature of the stool (fecal stones with fecal blockage, "ribbon" stools with tumors, "sheep feces" with chronic constipation, etc.).
♦ How hard did you have to push and was it painful to have a bowel movement?
♦ Did the patient feel the urge to defecate (in debilitated patients, the urge is absent)?
♦ Whether after a bowel movement there is a feeling of complete emptying of the bowels and satisfaction (in debilitated patients there may be a partial emptying with a feeling of dissatisfaction).
♦ Are there any pathological impurities in the feces: mucus, blood, undigested residues, etc.?
♦ If there is an admixture of blood, then when: at the beginning of defecation or at the end of it (differentiation between hemorrhoids and tumor of the rectum)?
Cancer patients have complaints indicating constipation:
♦ loose stools with a persistent feeling of incomplete emptying of the intestine is possible with a developed fecal blockage;**
♦ urinary incontinence is often the result of fecal blockage due to the anatomical proximity of the rectum and bladder;
♦ nausea and vomiting, unexplained by other causes;
♦ Pain along the colon.

When examining patients, attention should be paid to the characteristic general symptoms caused by intoxication: headache, general weakness, irritability, absent-mindedness, loss of appetite, specific fecal odor from the mouth, plaque on the oral mucosa and tongue.
Nursing care for constipation aims to restore and maintain the excretory function of the intestine.
In doing so, the following steps should be taken:
♦ promote the maximum possible physical activity of the patient, using elements of physiotherapy exercises and massage;
♦ explain to the patient and his relatives the need for fluid intake at the level of 2.5–3.0 liters per day;***
♦ to develop a high-fiber diet for the patient (variety of cooked vegetables and fruits, cereals);****
♦ Anticipate constipation as a side effect of medications (opiates, etc.) by prescribing accompanying therapy in the form of laxatives;
♦ Decide together with the patient what may be acceptable to him, talking about the various ways to eliminate constipation, passing on knowledge about the physiology of the intestine;
♦ for diseases in the perineal region (anus fissures, exacerbation of hemorrhoids) to treat them promptly and thoroughly, understanding that, experiencing pain during defecation, the patient will slow it down;

♦ give the patient the opportunity to independently cope with the problem (privacy, creating favorable conditions for the administration of physiological needs, etc.), which will spare his sense of shame and dignity.

Treatment for constipation

To restore and maintain the evacuation function of the intestine, it is often necessary to prescribe laxatives of various groups, cleansing and laxative enemas. In the absence of contraindications from the rectum, oil and hypertonic enemas are used as laxatives.
An oil enema coats and erodes the stool; for its setting, 100-200 ml of vaseline or vegetable oil heated to body temperature, a pear-shaped balloon and a gas outlet tube are required. Putting on rubber gloves and a protective apron, warm oil is drawn into the cylinder, and the gas outlet tube is lubricated with petroleum jelly. The patient is helped to lie on the left side with the legs bent and brought to the stomach. Having parted the buttocks, a gas outlet tube is inserted into the rectum to a depth of 15-20 cm, a cylinder of oil is attached to the tube and slowly inserted into the intestinal cavity.
An oil enema is usually given at bedtime. It is desirable that the foot end of the bed be slightly raised until morning. After a similar procedure in the morning of the next day, there is usually a stool.
Hypertonic enema designed for faster results. Its formulation is similar to the previous description, only instead of oil, 50–100 ml of a 10% solution of sodium chloride (a tablespoon per glass of water) or 20–30% magnesium sulfate (magnesia) solution is introduced. The patient is asked to force the will to keep the liquid in the intestines for 20-30 minutes, after which they lay a vessel or help to sit on the toilet.
In medical practice, laxative enemas (oil and hypertonic) are often used in debilitated patients, for whom the "classic" cleansing enema may be too tiring. However, in some cases it is necessary and can be applied with a modification of the technique applicable to a seriously ill patient. The idea is to introduce water into the intestine retrograde, proximal to the feces.
The patient is laid on a bed covered with an oilcloth hanging in a basin. Position - on the left side with legs bent at the knees. A thin polyvinyl chloride tube (Folley type urethral catheter No. 20, a tube from the infusion system) with a rounded end to avoid trauma to the mucous membrane (can be gently burned on fire), is inserted into the rectum at least 20 cm. holes.
A tube, previously lubricated with petroleum jelly, is inserted with screwing movements without much effort. The tip of the Esmarch mug is connected to the tube by means of an adapter or adapter and the valve opens. The jet of water should not be very fast, so as not to cause pain. If water does not enter the intestines, it is necessary to raise the mug higher and move the catheter. After the introduction of water, close the valve, carefully remove the catheter and give the patient a vessel. A cleansing enema can be considered successful if, after a while, feces come out with water.
To eliminate constipation in oncological practice, the drugs of the following groups are most often used:
♦ contributing to an increase in the volume of feces (forlax);
♦ osmotic laxatives that attract liquid into the intestinal lumen (drugs based on lactulose - dufalk, normase, magnesia);
♦ stimulants of peristalsis of the large intestine (sena preparations, bisacodyl, guttalax);
♦ softening stools and stimulating peristalsis of the lower intestines (suppositories with glycerin, bisacodyl).

Forlax when taken orally, it retains the volume of fluid contained in the intestine, which leads to increased peristalsis and restoration of the defecation reflex. The laxative effect most often occurs 24-48 hours after ingestion.
Start using 2 sachets 2 times a day. The contents of the sachet should be dissolved in a glass of water, but debilitated patients, as a rule, refuse to drink four glasses of the solution a day, and therefore have to be content with two glasses (a glass in the morning and evening) of greater concentration. With the appearance of a chair, they switch to a maintenance dose (two sachets per day) with a gradual replacement with drugs from other groups of laxatives against the background of measures that promote independent intestinal motility (see above).
Osmotic laxatives mobilize water into the intestines through high osmotic pressure; fecal masses are liquefied, peristalsis is stimulated. A representative of this group, dufalk is used at a dose of 15-30 ml 2-3 times a day before meals. If necessary, the daily dose can be increased to a maximum - up to 180 ml in three divided doses. When the effect occurs, they switch to a maintenance dose - 10 ml 2 times a day before meals. The drug is not used in diabetes mellitus, in any case - in disorders of carbohydrate metabolism.
Magnesia(magnesium sulfate) or "bitter salt" is used at a dose of 10-30 g dissolved in half a glass of water at night or 20 minutes before meals. The bitterness of this remedy is offset by the expected result.
Tableted drugs based on sena leaves (senadexin, senade) stimulate intestinal motility, and therefore spastic pains in the abdomen are possible, which can cause a negative reaction from patients. Usually taken at bedtime - up to 3 tablets. The effect comes in 6-10 hours.
Bisacodyl(5 mg per tablet) when taken orally, it works after 5-7 hours. The initial single dose is 1-2 tablets at bedtime, with insufficient effect and good tolerance - up to 3 tablets.
In cases where it is difficult for patients to swallow tablets, it is convenient guttalax. It is used as a solution of 10-15 drops in a small amount of water in the morning or evening. If necessary, you can increase the dose to 25 drops. The effect comes in 6-10 hours.
Rectal sve chi (suppositories), like enemas, are best inserted into the rectum after breakfast or after dinner, adapting to the rhythm of the reflex activity of the intestine. One or two candles are advanced to a height of p the fingertips of a gloved hand; action develops within an hour.

The fight against constipation requires great patience, a certain delicacy and knowledge. The nurse should often discuss with the doctor the maximum allowable doses of laxatives and the sequence of their use.

Treatment of fecal blockage

Fecal obstruction is the accumulation of dense feces in the rectum, which cannot be evacuated by the efforts of the body, despite the fact that a significant amount of fluid is released from the walls of the injured intestine into its lumen. Patients suffer from tenesmus (painful urge to defecate), but only a small amount of liquid feces, resembling diarrhea, is excreted, and normal defecation does not occur. Over time, the feces "clump" into fecal stones. With a digital examination of the rectum, the presence of a fecal blockage is established by a doctor or nurse without much difficulty.
Quite often, the only possible way to eliminate fecal obstruction may be digital (manual) removal of fecal stones from the rectum. The technique of such removal is simple: having received the patient's prior consent to the manipulation, he is laid on his left side with half-bent legs, placing a diaper under the buttocks, which then it will not be a pity to throw it away. Hands of a nurse in gloves. With the fingers of the left hand, the nurse spreads the buttocks of the patient and inserts the forefinger of the right hand, richly lubricated with vaseline, into the rectum. The movement is slow, "screwing". We must try not to hurt the patient. When fecal stones are found behind the sphincter, they put a finger behind the upper pole of the stone and, using the finger as a hook, remove the stone out.
If the fecal stone is large and cannot be divided into fragments, an oil enema should be given for several hours, after which it will be easier to remove it in parts.
With constipation, it is important to remember about intestinal obstruction, which can be acute, i.e. arising suddenly, and chronic, when it develops gradually or is manifested by repeated attacks of relative obstruction (intermittent obstruction).
The nurse must remember that chronic intestinal obstruction is manifested by periodic constipation with bloating, cramping abdominal pain. In the period of resolution of intestinal obstruction, diarrhea with copious liquid stools is observed, which is again replaced by constipation (a very characteristic syndrome in colon cancer!).
According to the mechanism of pathogenesis, intestinal obstruction can be mechanical (tumors, adhesions, volvulus, etc.) and dynamic, which is based on impaired intestinal motility, especially with asthenia in patients, the use of potent analgesics, antispasmodics, etc.
An important symptom of intestinal obstruction is the delay in the release of intestinal gases and feces. The pain, at first episodic, cramping, later becomes constant, excruciating. Patients to reduce pain take a forced position on their haunches or on all fours. There is bloating, muscle tension. The tongue becomes dryish, lined with a whitish-dirty coating, fecal smell from the mouth. Vomiting with an admixture of feces is a late and formidable sign!
If you suspect developing intestinal obstruction, you need to stop taking all laxatives, cancel enemas and urgently consult a doctor!

Want to know more - read:

1. T. Orlova. Constipation in cancer patients//Nursing, M. No. 5, 2008, pp. 44-47.
2. N. Opanasyuk. Constipation: differential diagnosis, modern approaches to treatment. doctor. Journal for practicing physicians//№2, 2002. P.26-29
3. A.N. Okorokov “Treatment of diseases of internal organs. Practical hand-in 3 t. T1 - 2nd ed. revised and additional 1998, Art. 400-402.
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Note.
◊ Colostomy ("kolon" - large intestine, "stoma" - passage) - an opening in the intestine, surgically formed from a part of the large intestine on the anterior abdominal wall and designed to expel intestinal contents.
** With confusion and the impossibility of productive contact with the patient, the presence of loose stools in him always requires the exclusion of fecal obstruction.
***Recommended volumes are not always achievable for debilitated patients; you should insist on at least one and a half liters per day.
**** For constipation, diet No. 3 is used, the purpose of which is to provide good nutrition and help normalize the act of defecation. For more details, see A.N. Okorokov “Treatment of diseases of internal organs: Prakt. hand-in, 3 vols., T1 - 2nd ed. revised and supplementary, 1998, pp. 400-402.

Victor DARCHINOV
Oncologist, Cherkasy Oncology Center