For this procedure, a single finger of a gloved hand is lubricated and inserted into the rectum. The stool is gently broken up and removed in pieces until the rectum is cleared. Digital disimpaction can be performed on its own or in tandem with rectal irrigation (douching).
This article looks at the various reason why digital disimpaction may be needed and the possible risk involved with this manual procedure.
Reasons for Digital Disimpaction
Digital disimpaction is not a recommended treatment for constipation unless the condition cannot be relieved by other methods or a person has a medical condition that significantly interferes with bowel movements.
Digital removal of feces (DRF)Disimpacting stool with digital maneuversDigital evacuationManual disimpactionManual elimination
Here are three reasons why digital disimpaction may be needed:
Fecal Impaction
Fecal impaction is a solid stool that is “stuck” in the rectum, typically as a result of chronic constipation. In addition to pain and bloating, fecal impaction can cause the overflow of diarrhea as fluids build behind the blockage. If left untreated, it can lead to ulcers, bleeding, and even tissue necrosis (death).
Causes and risk factors of fecal impaction include:
Physical inactivity Chronic or severe dehydration Not eating enough fiber Holding in bowel movements Opioid drug use Barium enemas Foreign object obstruction Enlarged prostate Pregnancy Being in traction (particularly if obese) Celiac disease Irritable bowel syndrome (IBS) Inflammatory bowel disease (IBD) Hypothyroidism
All of these conditions can lead to severe constipation by altering the consistency of stools and/or the normal contraction of the intestines.
Dyssynergic Defecation
People who experience chronic constipation due to a condition known as dyssynergic defecation are most likely to require digital evacuation.
Dyssynerigic defecation occurs when the nerves and muscles of the pelvic floor do not work together smoothly so as to produce a normal bowel movement. Essentially, the organs that facilitate a bowel movement are “out of sync.”
Also known as anismus, dyssynergic defecation is considered a type of pelvic floor dysfunction. Since defecation requires the voluntary contractions of the anal sphincter, the condition generally stems from the inability to voluntarily control these muscles.
Causes include:
Malformation of the anal canal Parkinson’s disease Rectocele (when the vagina bulges into the rectum) Rectal prolapse (when the rectum protrudes outside of the anal canal) Rectal ulcers
Biofeedback and physical therapy may also be recommended as a means to relax and better focus on anal sphincter control.
Spinal Cord Injuries
People with spinal cord injuries may need digital disimpaction as part of their daily bowel management. Manual disimpaction is considered a standard practice of care for people with severe injuries.
Motor vehicles accidents and severe falls are the most common cause of spinal cord injuries, but they can also be the result of a degenerative spinal condition or spinal tumors. The loss of bowel function may either be temporary or permanent.
Because a person with a spinal cord injury often has a loss of sensation around the anus and rectum, digital disimpaction should be performed by a healthcare professional (or a caretaker trained in the procedure) to avoid injury.
Risks and Considerations
It is not recommended that you use digital evacuation on a regular basis. You run the risk of injury, including anal fissures or rectal perforation, as well as hemorrhoids and infection. It can also cause the worsening of your condition if the anal sphincter is damaged.
In rare instances, fatal heart arrhythmias (irregular heartbeats) have been known to occur, most often in chronically ill older adults.
Your healthcare provider can do an assessment to figure out why your bowel movements are not normal. They will want to identify the underlying cause—whether it be a disease, structural defect, or obstruction—so that the appropriate short- and long-term solutions can be found.
Summary
Digital disimpaction is the removal of stool from the rectum using a gloved finger. It is used when a person is unable to pass stools due to severe constipation, fecal impaction, dyssynergic defecation, and spinal cord injuries.
Digital disimpaction may be performed by the person with constipation, a healthcare provider, or a caregiver trained in the procedure. It is sometimes used with rectal irrigation to gently clear the bowel.
Digital disimpaction is considered a short-term solution when all other reasonable options have failed. The regular use of digital disimpaction can cause hemorrhoids, anal fissures, rectal perforation, infection, and the worsening of defecation problems.
