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Should I Visit The ER For Severe Impaction And Pain Under The Rib Cage Despite Taking Strong Laxatives?
Question: I was teated in the er last Saturday for severe constipation.i was given er laxatives which cleared me halfway and I continued eating.i got severey impacted since then and woke with pain under my rib cage.i have had no bm in 4 days,i see my pcp t 1pm today but I hav taken strong laxatives every day the last 4 days and no bm at all,the impaction isn't in the rectal area.i canniotfeel te stool in my rectal are.the xray showed feces in my colon saturdat.the fecal impaction has moved higher up and tenpain went from my beely button area to under rib cage.shoulfd I go to the hosptipa now er or wait to see pcp.
I know this needs to bbe treate din the hospital since I have taken laxatives daily for 4 days and no bm at all.i am sevely impacte and pain is under rib cage.2 enemas were taken Monday along with er meds again lacalose,soritaol etc.don't I need to go to the er now since I haven't had bm in days and no otc laxative has helped.i see my pcp at 1pm today but I belive this can only be treated in the hospital to get manualy removed,it cannot be manuely removed thorough the rectal area since there is no feces in my rectal area.i am a nurse rtired so I know what manual removal with gloved fingers can do but sicnce there are no stools in rectal area don't they need to do procedure with machine to remove it high up in the colon.should I go to er now or wait to see pcp at 1pm.please reply soon.i would like to know if I should go to the er now to get treated sinc the pain has went to my chest areait isn't chest pain but the fecal impaction isso high up in the colon that the pain is moving up,it isn't sevre pain but the impcaton is sever should I wait to see pcp at 1pm or go to er
I know this needs to bbe treate din the hospital since I have taken laxatives daily for 4 days and no bm at all.i am sevely impacte and pain is under rib cage.2 enemas were taken Monday along with er meds again lacalose,soritaol etc.don't I need to go to the er now since I haven't had bm in days and no otc laxative has helped.i see my pcp at 1pm today but I belive this can only be treated in the hospital to get manualy removed,it cannot be manuely removed thorough the rectal area since there is no feces in my rectal area.i am a nurse rtired so I know what manual removal with gloved fingers can do but sicnce there are no stools in rectal area don't they need to do procedure with machine to remove it high up in the colon.should I go to er now or wait to see pcp at 1pm.please reply soon.i would like to know if I should go to the er now to get treated sinc the pain has went to my chest areait isn't chest pain but the fecal impaction isso high up in the colon that the pain is moving up,it isn't sevre pain but the impcaton is sever should I wait to see pcp at 1pm or go to er
Brief Answer:
Initially, take Miralax (polyethylene glycol electrolyte solution) then wait for 6 hours, if not relieved in 6 hours go to ER for manual evacuation of stool.
Detailed Answer:
Hi,
There is impacted stool in your rectum causing severe constipation.
Initially take Polyethylene glycol-electrolyte solution (Miralax) is used to empty the colon. The medication also contains electrolytes to prevent dehydration and other serious side effects that may be caused by fluid loss as the colon is emptied. It is a osmotic laxative and will help you pass your bowel.
If still not cleared digital manual evacuation of bowel should be done by nursing staff.
After that -
- Please start taking Syp. Lactulose 30 ml once daily at night time(laxative).
- Psyllium husk (natural fiber) should be taken 2 tsp once daily soak in half a cup of lukewarm water.It increases the bulk of stool, lubricates stool and helps in the formation of well-formed stools
- Try to increase your daily fiber intake gradually. maintain it at 25-30 grams/day.
- Take probiotic supplements they are good bacteria and will improve digestion.
- Keep your fiber intake at about 25-30 gram daily.
- Take 1 cup of fruits like orange banana pears that is enough to meet your extra fiber requirement.
- Take lots of curd and probiotic rich food.
Hope I have answered your query. Please feel free to write a follow up question in case you need more details.
Regards,
Dr. Sunil
Gastroenterologist
Initially, take Miralax (polyethylene glycol electrolyte solution) then wait for 6 hours, if not relieved in 6 hours go to ER for manual evacuation of stool.
Detailed Answer:
Hi,
There is impacted stool in your rectum causing severe constipation.
Initially take Polyethylene glycol-electrolyte solution (Miralax) is used to empty the colon. The medication also contains electrolytes to prevent dehydration and other serious side effects that may be caused by fluid loss as the colon is emptied. It is a osmotic laxative and will help you pass your bowel.
If still not cleared digital manual evacuation of bowel should be done by nursing staff.
After that -
- Please start taking Syp. Lactulose 30 ml once daily at night time(laxative).
- Psyllium husk (natural fiber) should be taken 2 tsp once daily soak in half a cup of lukewarm water.It increases the bulk of stool, lubricates stool and helps in the formation of well-formed stools
- Try to increase your daily fiber intake gradually. maintain it at 25-30 grams/day.
- Take probiotic supplements they are good bacteria and will improve digestion.
- Keep your fiber intake at about 25-30 gram daily.
- Take 1 cup of fruits like orange banana pears that is enough to meet your extra fiber requirement.
- Take lots of curd and probiotic rich food.
Hope I have answered your query. Please feel free to write a follow up question in case you need more details.
Regards,
Dr. Sunil
Gastroenterologist
Above answer was peer-reviewed by :
Dr. Nagamani Ng
you don't understand.i took oral laxatives for 4 days strait and e enemas.i did miralx daily.i have been to er last 4 days they send me home.ihavent had any bm in 4 days,despite laxatives I am extremely sick.i went to the er already do I need to go back now.why are you saying digital manual evacuation can be done by nursing staff.i have no feces in y rectal area.i am retired lpn I can feel my rectal area there is no feces.the impaction is in my colon.i need operative procedure should I go to er now,you stated to take miralax and wait 6 hours,i have taken miralax already and other laxtives for 4 days and er laxatives nothing has helped should I go back to e
Brief Answer:
Go for trans-anal irrigation.
Detailed Answer:
Hi,
If enemas, Miralax and laxatives are not helpful then the only way out is water irrigation. It involves pushing a small hose up through the rectum and into the colon. The hose connects to a machine that emits water through the tube. This is also termed as trans-anal irrigation. The success rate of irrigation for functional constipation is about 50%, comparable to or better than the response seen in trials of pharmacological therapies.
Yo should go to ED and get it done.
Apart from that a colonoscopy and MRI abdomen should be done to rule out the cause of impaction.
You need to go for bowel retraining program. A specially trained nurse or therapist will help you with that.
Even if this is not successful you can go for surgery.
Hope I have answered your query.
Regards,
Dr. Sunil
Gastroenterologist
Go for trans-anal irrigation.
Detailed Answer:
Hi,
If enemas, Miralax and laxatives are not helpful then the only way out is water irrigation. It involves pushing a small hose up through the rectum and into the colon. The hose connects to a machine that emits water through the tube. This is also termed as trans-anal irrigation. The success rate of irrigation for functional constipation is about 50%, comparable to or better than the response seen in trials of pharmacological therapies.
Yo should go to ED and get it done.
Apart from that a colonoscopy and MRI abdomen should be done to rule out the cause of impaction.
You need to go for bowel retraining program. A specially trained nurse or therapist will help you with that.
Even if this is not successful you can go for surgery.
Hope I have answered your query.
Regards,
Dr. Sunil
Gastroenterologist
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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