Fecal Impaction a Ɛyɛ Den wɔ Nkwakoraa ne mmerewa mu: Nea enti a Nsu "Overflow Diarrhea" Masks a Rock-Hard Blockage ne Asiane a Ɛwɔ sɛ Bowel Perforation¶

Sɛ ɔpanyin a ne mfe akɔ anim a ɔyɛ mmerɛw, ɔda mpa so, oprehyɛn akyi, adwenemhaw, anaa opioid sa no yare no fi ase mpofirim nya nsu bruu a ɛpae, ɛyɛ huam, ɛyɛ nsu a ɛsen kɔ wɔn mpanyimfo tiawa mu a wontumi nhyɛ so simma 30 biara a, ɛkame ayɛ sɛ abusua no ahwɛfo ne ayarehwɛfo aboafo a wonni osuahu mpo de wɔn nsa hwehwɛ yare koro no ara mu: "Maame wɔ yafunu mu mmoawa anaasɛ atiridiinini; ma no Imodium (loperamide) anaa Pepto-Bismol na ama atiridiinini no agyae, na gyae nnuru biara a ɛma nsu a ɛyɛ mmerɛw ma no."

Wɔ nkwakoraa ne mmerewa aduruyɛ mu no, saa mfomso no betumi akum obi. Wɔ nkwakoraa ne mmerewa atrae ne wɔn a wɔakɔ fie no mu bɛyɛ ɔha biara mu nkyem 70 mu no, nsu a ɛyɛ nsu a wontumi nhyɛ mu mpofirim, titiriw wɔ nnafua 4 kosi 10 a wɔde dwensɔtwaa nketenkete, ɛyɛ den, anaasɛ enni hɔ akyi no yɛ abirabɔ "Overflow Diarrhea" (encopresis): nsu a nsu nnim, calcified, ɔbotan a ɛyɛ den fecaloma (fecal impaction) a ne kɛse te sɛ a wɔde grapefruit abɔ mu denneennen wɔ rectal vault anaa sigmoid colon mu te sɛ cork a ɛwɔ toa mu. Esiane sɛ nsu a ɛyɛ den ntumi ntwam wɔ baabi a asiw no nti, ɔyare mmoawa a ɛwɔ akyi berɛmo mu no yɛ nsu a akyea wɔ plug no atifi no ma ɛyɛ nsu a ɛyɛ fĩ ne nsu a ɛyɛ fĩ, na ɛpiapia ade a ɛyɛ den te sɛ ɔbotan no anoano na ɛtwetwe fi mu a wɔmpɛ. Sɛ woma saa ɔpanyin no loperamide ( .Imodium) sɛ ɛbɛma dwensɔtwaa no ayɛ mmerɛw, anaasɛ sɛ wohwie nnuru a ano yɛ den a ɛkanyan anom (senna, . bisacodyl, . magnesium citrate) fi soro kɔ wɔn yafunu mu de hyɛ dwensɔtwaa a ɛwɔ soro no ma ɛtwetwe denneennen wɔ ɔbotan a ɛwɔ akyi berɛmo mu a entumi nkɔ so, ischemic, krataa teateaa a ɛwɔ akyi berɛmo mu ɔfasu a wɔatrɛw mu denneennen wɔ nsu a ayɛ den no so no betumi atetew (stercoral ulceration ne stercoral perforation), atow nsu a wɔannoa agu yafunu no mu na ɛde fecal peritonitis ne septic shock a ɛde a Nnipa dodow a wowuwu ɔha biara mu nkyem 35 kosi 50. Sɛ ɔpanyin bi a ne mfe akɔ anim a wosusuw sɛ wayɛ akisikuru anaasɛ ne yafunu a ɛboro so nya yafunu a ɛyɛ den/te sɛ kyerɛwpon, yafunu mu yaw kɛse, ɔfe (titiriw tuntum ahabammono bilious anaa brown feculent fe), mogya tu wɔ ne menewa mu, mogya mmoroso, anaasɛ adwene mu naayɛ/ɔbrɛ a emu yɛ den a, frɛ wo mpɔtam hɔ nɔma a egye ntɛmpɛ (911 wɔ United States ne Canada no, . 112 wɔ Europa Aman Nkabom no nyinaa mu, . 999 wɔ United Kingdom) anaasɛ kɔ yɛn nɔma ahorow a egye ntɛmpɛ directory a wɔde kyerɛw nsɛm. Sɛ wopɛ nkwakoraa ne mmerewa ayaresa mu nsɛm a egye ntɛmpɛ a ɛfa ho a, hwɛ adwene a ɛyɛ basaa mpofirim wɔ nkwakoraa ne mmerewa mu: UTI a ɛyɛ komm urosepsis vs. stroke ne nea enti a ayarefo a wɔn mfe akɔ anim nni atiridiinini, . ayaresabea adwenemhaw ne aduruyɛ mu nsɛm a wɔka de kyerɛ nkwakoraa ne mmerewa, na polypharmacy, nnuru a wɔnom boro so, dodow a wɔannye, ne mfomso a ɛwɔ pill organizer mu.

Yɛ eyi mprempren¶

1. MMFA nnuru a ekum akisikuru mma DA (Imodium / loperamide, . Lomotil / diphenoxylate-atropine, anaasɛ Pepto-Bismol / bismuth) ma ɔpanyin bi a onya nsuo a ɛtɔ mpofirim kɔsi sɛ oduruyɛfoɔ bɛhwɛ sɛ rectal fecal impaction. Giving Imodium wɔ ɔyarefo a ɔwɔ atiridiinini a ɛboro so a ɛne ne ho bɔ abira no ma akyi berɛmo no mu ntini no tumi yɛ mmerɛw koraa, na ɛdan nsu a ɛtɔ fã bi no ma ɛbɛyɛ dwensɔtwaa kɛse a ɛsiw koraa a edi awu anaasɛ megacolon a awuduru wom.
2. MMFA nnuru a ano yɛ den a ɛkanyan anom anaasɛ osmotic laxatives a ano yɛ den mma DA (Senna, . Dulcolax / bisacodyl aduru a wɔnom, . Magnesium Citrate nkotoku, . Castor Oil, anaa Golytely / high-dose PEG-3350) fi soro ANSA na wɔahwɛ akyi berɛmo mu plug a ɛwɔ fam no na wɔayi afi ase. Sɛ fecaloma a ɛyɛ den te sɛ ɔbotan reto akyi berɛmo no mu a, ɛhyɛ akyi berɛmo no ma ɛbɔ denneennen fi soro no ma nsuo nhyɛsoɔ kɔ ischemic sigmoid ɔfasuo no so tẽẽ (stercoral perforation). Mmara a ɛfa Geriatric Gastroenterology ho: Bere nyinaa yi distal fecal impaction fi BELOW kan (lubricated digital disimpaction + oil-retention/warm-water enema) ansa na wɔde nnuru a wɔde sa anom a efi soro ama.
3. Hwɛ "Stercoral Colitis / Bowel Perforation Emergency Red Flags" 5 a ɛhwehwɛ sɛ wode ambulance tu kwan ntɛm ara kɔ Ayaresabea ER kɔyɛ Yafunu CT Scan:
4. Akisikuru a emu yɛ den, a ɛyɛ den anaasɛ yafunu/akyi a ɛyɛ nnam, anaasɛ yafunu a ɛyɛ den, ɛtrɛw, ɛyɛ mmerɛw (peritoneal guarding).
5. Akisikuru ne ɔfe a ɛkɔ so (a entumi mma nsu no nkɔ fam, anaasɛ mogya a ɛyɛ ahabammono tuntum anaa nsu a ɛyɛ bruu a ɛyɛ huam a ɛfe).
6. Mogya kɔkɔɔ a ɛhyerɛn anaa mogya a ɛyɛ tuntum a ɛyɛ maroon a ɛtwam fi akyi berɛmo no mu (ischemic stercoral ulcer bleeding).
7. Gas (flatus) mpo a wontumi ntwa mu koraa a ɛka ho ne ahome a ɛho ayɛ fĩ ne ahome a emu nnɔ ntɛmntɛm.
8. Delirium/adwene a ɛyɛ basaa a emu yɛ den mpofirim, koma bɔ ntɛmntɛm (>100 bpm), mogya mmoroso, atiridiinini, anaa ɔhyew a ɛba fam (<36.0°C / . 96.8°F).
9. Hwɛ sɛ ɔpanyin no nso wɔ "Urinary Retention" a emu yɛ den (a ontumi tow nsu anaasɛ ɔtwetwe nsu nketenkete) wɔ dwensɔtwaa ho asɛm no nkyɛn anaa. Wɔ ɔpanyin a ne mfe akɔ anim akyi berɛmo mu no, nsu a ɛyɛ den kɛse a ɛte sɛ ɔbotan a ɛba akyi berɛmo mu no bubu urethra ne bladder neck no honam fam wɔ awotwaa mu dompe no so fi akyi, na esiw nsu a ɛsen koraa na ɛkanyan adwenemhaw a emu yɛ den ne hydronephrosis (asaabo a ɛboa).
10. Besrɛ mpa ho "Digital Rectal Exam (DRE)" a ɛyɛ brɛoo a ofie akwahosan/hospice ɔyarehwɛfo, oduruyɛfo a ɔba hɔ, anaa ntɛmpɛ/ER ayaresabea hɔ nnɛ. Egye oduruyɛfo a ɔwɔ nsateaa a wɔde nsateaa a wɔde srade ahyɛ mu na wate nka sɛ ebia nsu a ɛyɛ den te sɛ dɔte anaa ɔbo te sɛ nsu a ɛyɛ den te rectal ampulla no mu (hyɛ no nsow: atwa ho ahyia Fecal impactions ɔha biara mu nkyem 70 tra akyi berɛmo a ɛwɔ fam no mu pɛɛ a nsateaa a wɔde nsateaa ahyɛ mu no betumi adu, bere a ɔha biara mu nkyem 30 tra soro wɔ sigmoid colon mu na ɛhia sɛ wɔyɛ yafunu mu X-ray anaa CT scan na ama wɔahu).
11. Sɛ ɔyarefoɔ no wɔ komayareɛ, pacemaker/arrhythmia abakɔsɛm, anaasɛ ɔnom beta-blockers a, hwɛ sɛ "Vasovagal Drop" (koma a ɛbɔ brɛoo mpofirim na ɔtotɔ piti) wɔ berɛ a rectal disimpaction, na MFA "Fleet Sodium Phosphate Enema" a wɔtɔn a wɔmfa nnuru nhyɛ mu nni dwuma DA wɔ mpanyimfo BIARA a wadi boro mfeɛ 65 mu.

Gyinaesi dua: Dwoodwoo triage a wosusuw sɛ fecal impaction vs. ɔyare mmoawa diarrhea¶

flowchart TD
    A["Senior Nya Nsuo a Ɛyɛ Nsuo a Ɛretu Mpofirim (‘Diarrhea’), Yafunu a Ɛhohoro, Delirium, anaasɛ Wantwam wɔ Nsuo a Ɛyɛ Pɛ mu wɔ Nnafua 4+ mu"] --> B{"So Frɛko Kɔkɔɔ Bi Bi Wɔ Hɔ? (Yafunu mu yaw a emu yɛ den, yafunu a ɛtrɛw denneennen, ɔfe, mogya a ɛba akyi berɛmo mu, atiridiinini, anaa mogya mmoroso)"}
    B -->|"YIW: Frɛmfrɛm Kɔkɔɔ 1 biara a Ɛwɔ Hɔ"| C["FRE 911 / KƆ HOSPITAL ER Ntɛm ara (Fa ZERO aduan, ZERO nsu, ZERO laxatives, ne ZERO Imodium fa ano)"]
    C --> D["ER Protocol: Non-Contrast/IV-Contrast CT Scan of Abdomen & Pelvis de Pow Stercoral Colitis, Volvulus, anaa Perforation -> IV Nsu, NG Decompression, & Monitored Disimpaction"]
    B -->|"DABI: Yafunu yɛ mmerɛw/ɛnyɛ mmerɛw, ɔfe biara nni hɔ, mogya biara ntu, vitals stable"| E["Suspect PARADOXICAL OVERFLOW DIARRHEA Around a Fecal Impaction (Titiriw sɛ worenom Opioids, Iron, Calcium, anaa Anticholinergics a)"]
    E --> F["Ma Ɔyarehwɛfo anaa Oduruyɛfo Nyɛ Digitals Rectal Exam (DRE) a Wɔde Srade a Wɔde Srade Ayɛ Dwo ."]
    F -->|"1. Hard Stool Mass Felt wɔ Rectal Vault (Distal Nkɛntɛnso - 70% wɔ Nsɛm no mu) ."| G["ANAMMƆN 1 (EFI ASƐSE): Fa 2% Lidocaine Jelly -> Digital Fragmentation a Ɛyɛ Dwo + Mineral Oil Enema (Wɔde Nkyene/Tap-Nsu Enema a Ɛyɛ Ɔhyew Di akyi Nnɔnhwerew 1-2; MMFA Sodium Phosphate DA)"]
    F -->|"2. Rectal Vault Da mpan, Nanso Yafunu ayɛ ma Stool wɔ Palpation/X-Ray (High Sigmoid Impaction - 30% of Cases) ."| H["Oduruyɛfo Kyerɛkyerɛ Softening Protocol: Nsu a Ɛyɛ hyew/Mineral Oil Enema anaa Polyethylene Glycol a Wɔakyekyɛ mu (PEG-3350) a Ɛwɔ Tenabea a Ɛkorɔn no, Wɔde X-Ray Pow Akwanside a Ɛba Awie pɛyɛ"]
    G --> I["ANAMMƆN 2 (EFI ATIFIRI - BERE A WƆAPORO RECTAL PLUG NKUTOO): Fi ase Siesie Daa Daa Polyethylene Glycol (MiraLAX 17g) + Senna (Sɛ wowɔ Opioids so a) na Siw Nsan Ba"]
    H --> I

Paradoxical "Overflow Diarrhea" vs. Nokware Infectious Diarrhea: Sɛnea wobehu nsonsonoe¶

Ansa na wobɛma ɔpanyin bi aduru bi a ɛbɛma wagyae akisikuru, anaasɛ aduru a wɔde yi akisikuru a ɛbɛma wagyae akisikuru no, fa saa ayaresabea nhwehwɛmu pon yi kyerɛ nsonsonoe a ɛda Paradoxical Overflow Incontinence ne acute gastroenteritis anaa C ntam. difficile akyi berɛmo mu yare: .

Nea enti a Fecal Impaction kum: "Stercoral Colitis" ne "Stercoral Perforation".¶

Nnipa pii susuw sɛ akisikuru yɛ ade a ɛhaw adwene a asiane biara nni ho. Wɔ ɔpanyin a wadi mfe 80 mu no, fecal impaction a wɔansa no yɛ oprehyɛn bere ɔtopae a ɛbɔ a ɛkɔ so fa akwan abiɛsa a edi awu mu:

flowchart TD
    A["Ɔfã 1: Fecaloma a Wɔyɛ (Nnafua 4 kosi 10) ."] --> B["Nsuo kɔ so san twetwe firi nsuo a akyea wɔ akyi berɛmo ne sigmoid colon -> Nsuo no mu yɛ den ma ɛbɛyɛ ‘Stercoraceous Fecaloma’ a ɛyɛ calcified, te sɛ ɔbotan a ɛntumi mfa anal canal no mu"]
    B --> C["Ɔfã 2: Stercoral Colitis & Pressure Ischemia (Nna a Ɛto so 7 kosi 14) ."]
    C --> D["Fecaloma a ɛretrɛw te sɛ ɔbotan a ɛyɛ den no mia rectosigmoid colon no mucosal fasu no so a nhyɛso boro capillary mogya a ɛsen (>32 mmHg) -> Ɛtwa mogya a ɛkɔ dwensɔtwaa no fasu no mu, na ɛde deep necrotic ‘Pressure Ulcers’ (Stercoral Ulcers) ba colon no mu"]
    D --> E["Ɔfã 3: Stercoral Perforation & Fecal Peritonitis (35-50% Nnipa a Wowuwu) ."]
    E --> F["Sɛ obi de nnuru a ano yɛ den a ɛkanyan anom fi soro ma (anaasɛ ɔyarefo no twetwe no denneennen) a, dwensɔtwaa fasu a ɛyɛ teateaa a ɛte sɛ krataa no mu tetew -> Nsu a ɛyɛ nsu hwie gu awotwaa a ɛnyɛ ɔyare mmoawa no mu -> Rapid Gram-negative/anaerobic septic shock"]

Sɛnea ayaresabea adwumayɛfo hu "Stercoral Colitis" wɔ ER CT Scan so¶

Sɛ wo dɔfo no nnyaa dwensɔtwaa ankasa wɔ dapɛn biako mu na onya yafunu mu yaw, adwene tu fra, atiridiinini, anaasɛ mogya mu nkwammoaa fitaa anaa lactic acid dodow a ɛkɔ soro a, si so dua sɛ wɔnyɛ Non-Contrast (anaa IV-Contrast) CT Scan of the Abdomen and Pelvis wɔ Emergency Department, na ɛnyɛ flat plain X-ray kɛkɛ (KUB).

• CT scan da radiographic sɛnkyerɛnne abiɛsa a wɔtaa hu a ɛkyerɛ Impending Stercoral Perforation adi:
• Massive Fecaloma Distension: Nsuo kɛseɛ a ɛyɛ den, ɛtaa yɛ calcified a ɛtrɛw rectosigmoid colon no mu kɔ >6 cm (2.4 in) ntwemu.
• Focal Bowel Ɔfasu a Ɛyɛ Den (>3 mm): Edematous, inflamed colonic wall a wɔakyekyere no denneennen wɔ fecaloma no ho.
• Pericolonic Fat Stranding & Mucosal Discontinuity: Ɔfe a ɛtwetwe kɔ srade a atwa akyi berɛmo no ho ahyia no mu (anaasɛ extraluminal free air ahurututu nketenkete a ɛkyerɛ sɛ akyi berɛmo no ayɛ micro-perforated dedaw).
• Nea enti a Stercoral Colitis a wohu no sesa biribiara: Sɛ Stercoral Colitis wɔ CT scan so pɛ a, mpa ho ayarehwɛfo enemas a wɔnhwɛ so anaasɛ anifuraefo dijitaal nhwehwɛmu a emu yɛ den betumi afa necrotic ulcerated bowel wall no mu tẽẽ. Ayarefo a wɔwɔ Stercoral Colitis no hia sɛ wɔde wɔn kɔ ayaresabea, IV broad-spectrum antibiotics (kata Gram-negative rods ne anaerobes), oprehyɛn/gastroenterology-kyerɛ kwan brɛoo disimpaction wɔ tebea a wɔhwɛ so, anaasɛ laparotomy ntɛm ara sɛ mframa a ɛnyɛ hwee/perforation wɔ hɔ a.

Ayaresa nhyehyɛe a ahobammɔ wom: Sɛnea wɔtew distal fecal impaction ("From Below First, Never Above")¶

Sɛ oduruyɛfo anaa ɔyarehwɛfo a ɔrekɔsra no si so dua sɛ distal rectal fecal impaction ANNI sɛnkyerɛnne biara a ɛkyerɛ sɛ tokuru, peritonitis, anaa mogya tu a, ayaresabea nhyehyɛe a ahobammɔ wom, anammɔn anammɔn a nkwakoraa ne mmerewa ho animdefo ne ayarehwɛfo a wɔhwɛ wɔn a wɔyare ayarehwɛfo de di dwuma de yi akwanside no fi hɔ dwoodwoo ni:

Anamɔn 1: Di kan di nnuru na fa srade a wɔde kum nipadua no gu (Preventing pain and Vasovagal Syncope) .¶

• Nea enti a ɛnsɛ sɛ woma obiara yɛ "dry" anaasɛ un-numbed manual disimpaction da: Sɛ wotrɛw anal canal ne rectum no mu a, ɛkanyan pelvic parasympathetic vagus nerve fibers. Wɔ ɔpanyin a ɔyɛ mmerɛw mu no, akyi berɛmo mu trɛw a ɛyɛ yaw kanyan Vasovagal Reflex ntɛm ara: koma bɔ kɔ fam kodu mfe 30 (severe bradycardia), mogya mmoroso so tew kɛse, na ɔyarefo no tumi totɔ piti anaasɛ koma no ntumi nyɛ adwuma yiye wɔ mpa no so pɛɛ.
• Ahosiesie a Ahobammɔ:
• Fa ɔyarefo no si Left Lateral Sims’ Position (a ɔda wɔn benkum so a ne kotodwe nifa abɔ soro akɔ soro akɔ soro akɔ koko no mu, a ɛma abɔde mu kwan a ɛkɔ akyi berɛmo no mu ne akyi berɛmo a ɛsiane no hyia).
• Hwɛ koma a ɛbɔ ne mogya mmoroso mfiase ansa na woafi ase.
• Fa ** hyɛ mu.5 to 10 mL of sterile 2% Lidocaine Hydrochloride Jelly (Anesthetic Lubricant)** de kɔ akyi berɛmo no mu ne akyi berɛmo no ase denam syringe ano a ɛnyɛ nnade anaa nsateaa a wɔde nsateaa ahyɛ mu so, na twɛn simma 5 kosi 10 a edi mũ ma mpɔtam hɔ aduru a wɔde kum nipadua no no ntumi nyɛ akyi berɛmo no mu ntini a ɛyɛ mmerɛw na ɛma ɛyɛ mmerɛw ansa na woabɔ mmɔden sɛ wobɛma ayɛ mmerɛw.

Anamɔn 2: Ma ade a ɛyɛ den te sɛ ɔbotan yɛ mmerɛw ANSA na woabubu ("Oil-Retention First" Mmara) .¶

• Sɛ oduruyɛfo no nsateaa a wɔde nsateaa ahyɛ mu no bɔ nsu a ɛyɛ den te sɛ dɔte a ayow anaa semɛnte na ɛsõ dodo sɛ ɛbɛfa ahurututu no mu a ɛnyɛ hwee a, mmɔ mmɔden da sɛ wode ahoɔden bɛtwe bɔɔl kɛse a ɛyɛ den te sɛ ɔbo afi mu (a ɛtetew akyi berɛmo no mu ntini ne akyi berɛmo mu ntini no mu).
• Enema a Ɛwɔ Afã Abien Ntoatoaso (Ngo a Edi Kan, Nsu a Ɛyɛ hyew Nea Ɛto so Abien):
• Nea edi kan no, Fa Mineral Oil Retention Enema (100 to 150 mL of warm mineral oil or olive oil): Ma ɔyarefo no nkura ngo no mu wɔ ne menewa mu simma 30 kosi 60. Ngo no hyɛn nsu a ayow no mu mpaapaemu mu, de srade sra akyi berɛmo no afasu, na ɛdan semɛnte a ɛyɛ den ma ɛdan dɔte a ɛyɛ mmerɛw.
• Nea ɛto so abien, Gentle Digital Fragmentation ("Scissoring / Scooping"): Sɛ wohyɛ nsateaa abien a wɔde srade a ɛtumi nwura nsuo mu sra wo ayamye mu (Surgilube / . K-Y) anaa 2% Lidocaine jelly, oduruyɛfo no de nsateaa biako a ɔde kyerɛ ade hyɛ brɛoo fa akyi berɛmo no nkyɛn fasu no mu kɔ nsu a ɛwɔ nsu no mfinimfini a ayɛ mmerɛw no mu, de brɛoo flexing motion di dwuma de bubu asinasin nketenkete, na oyi fi mu nkakrankakra, gyina simma 2 biara ma ɔyarefo no home na ɔhwɛ ne koma mu ntini, na ogyae ntɛm ara sɛ mogya bi retu anaasɛ ɛyaw a emu yɛ den ba.
• Nea Ɛto so Abiɛsa, Tap-Nsu a Ɛyɛ Ɔhyew a Ɛdɔɔso Baaba, Nkyene a Ɛyɛ Daa, anaa Docusate (Enemeez) Enema: Sɛ wɔsɛe plɔg titiriw a ɛwɔ fam no wie a, wɔde nhyɛso a ɛba fam brɛoo Warm Normal Saline (0.9% NaCl) anaasɛ Tap-Nsu a Ɛyɛ Ɔhyew Enema ( .250 to 500 mL, sɛn hɔ a ɛnkɔ soro nsen 30 to 45 cm [12 to 18 in] asen no atifi), anaase a 5 mL Docusate Sodium ( .Enemeez) mini-enema, hohoro asinasin a aka no yiye. (Mfa soapsuds enemas, hydrogen peroxide enemas, anaa sodium phosphate enemas nni dwuma da, a ne nyinaa de nnuru a ɛma obi nya colitis).

Anamɔn 3: "Daily Bowel Regimen From Above" a wobefi ase (bere a ɔkwan a ɛwɔ fam no mu da hɔ akyi NKUTOO) .¶

Sɛ rectal vault no mu da mpan koraa na ɔyarefo no refa nsu a ɛyɛ mmerɛw ne gas mu a, ɛsɛ sɛ wufi ase ntɛm ara yɛ Daily Preventative Bowel Regimen efisɛ rectum a atrɛw, atonic (megarectum) bɛsan anya nkɛntɛnso wɔ nnafua 5 ntam sɛ wɔansa a.

Fa nnuru a wɔde fa dwensɔtwaa ano a ɛyɛ adwuma, ne nea mfaso nni so anaasɛ asiane wom toto mpanyimfo a wɔn mfe akɔ anim ho:

Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

Fa aban dwumadi ahorow a egye ntɛmpɛ, nkwakoraa ne mmerewa a wɔpaw wɔn, ne ayarehwɛfo a wɔhwɛ wɔn wɔ fie yi di dwuma bere a wosusuw sɛ ɔpanyin bi a ne mfe akɔ anim anya nsu mu nsu, akisikuru a ɛboro so, anaasɛ yafunu mu frankaa kɔkɔɔ no:

• Amerika:
• EMS a Ɛho Hia Ntɛmntɛm (Ma Yafunu a Ɛyɛ Den, Ɛyaw a Ɛyɛ Den, Fefe, Mogya a Ɛtu wɔ Akyi berɛmo mu, anaa Sepsis): Frɛ 911 na ɛyɛ.
• Homebound / Hospice Skilled Nurse Disimpaction Visit: Sɛ w’awofoɔ akyerɛw ne din wɔ Medicare Home Health Care anaa Hospice a, frɛ adwumayɛbea no 24/7 On-Call Registered Nurse (RN) Line ansa na woakɔ ER ama distal impaction a ɛnyɛ den; ofie akwahosan anaa hospice RN a ne ho akokwaw betumi ayɛ mpa ho dijitaal rectal nhwehwɛmu, de mineral oil/saline enema ama anaa Enemeez mini-enema, na fa afiri a wɔde hwehwɛ akisikuru a wotumi fa so hwɛ sɛ ebia nsu no nkɔ mu wɔ w’awofo mpa mu pɛɛ.
• FDA MedWatch Kɔkɔbɔ a Ɛfa Sodium Phosphate Nneɛma Ho: Hwɛ FDA Nnuru Ahobammɔ Nkitahodi a ɛyɛ aban de no mu (Sodium Phosphate Nnuru a Wɔtɔn wɔ Anom ne Awotwaa Mu: Asiane a Ɛho Hia Nanso Ɛyɛ Aniberesɛm a Ɛwɔ Nsu a Ɛma Nsu a Ɛma Nsu a Ɛma Nnuru ne Adwene/Adwene/Awuduru a Ɛwɔ Mpanyimfo a Wɔanyinyin Mu) wɔ fda.gov na ɛyɛ.
• Canada:
• Ntɛmntɛm: Frɛ 911 na ɛyɛ.
• Ɔmantam 24/7 Ayarehwɛfo Triage & Ofie Hwɛ Ayarehwɛfo (811): Frɛ ** .811** (Health811 wɔ Ontario, Info-Santé wɔ Quebec, HealthLink BC) anaa wo mantam Fie ne Mpɔtam Hwɛ Mmoa Dwumadibea ayarehwɛfo kuw a wɔyɛ ho biribi ntɛmntɛm no bisa sɛ wɔnyɛ ayarehwɛfo dwensɔtwaa ne akisikuru nhwehwɛmu a egye ntɛmpɛ wɔ fie.
• Aman Nkabom:
• Ntɛmntɛm: Frɛ 999 sɛ wopɛ yafunu/tokuru ho sɛnkyerɛnne a emu yɛ den a, anaa frɛ NHS 111 (24/7) sɛ wɔbɛsoma District Nursing / Community Urgent Care Team (Dɔnhwerew 2 Mpɔtam Hɔ Mmuae - UCR) akɔ ɔpanyin no fie.
• NICE Ayaresabea Akwankyerɛ a ɛfa Faecal Incontinence & Impaction (CG49): Wɔ NICE Akwankyerɛ CG49 (Faecal incontinence in adults) ne Royal College of Nursing (RCN) Bowel Care: Management of Lower Bowel Dysfunction protocols ase no, wɔatete NHS District Nurses sɛ wɔnyɛ ofie dijitaal rectal nhwehwɛmu, administer Arachis ngo (peanut ngo; di kan hwɛ sɛ nut allergy) anaa ngodua ngo a ɛkora enemas / sodium citrate (Micralax) micro-enemas, anaasɛ fi ase yɛ Macrogol ( .Movicol / . Cosmocol / . Laxido) escalating disimpaction regimen (ɛkɔsi nkotoku 8 a wɔde gu mu da biara da 1 liter nsuo a ɛboro nnɔnhwerew 6 bere a wɔayi dwensɔtwaa a ɛsiw/tokuru koraa no afi mu).
• Europa Aman Nkabom:
• Ntɛmntɛm: Frɛ 112 (anaasɛ 116 117 wɔ Germany ma Ärztlicher Bereitschaftsdienst ofie-frɛ oduruyɛfo, 15 / . SOS Médecins wɔ France). Wɔ Europa nkwakoraa ne mmerewa nnuruyɛ gyinapɛn ase no, Macrogol 3350/4000 ne aduru a wɔde siesie ne nea wɔmfa ntokuru nni mu a wɔde ka rectal Clyss-Go / Normacol anaa ngo a wɔde sie enemas (a wɔkwati hypertonic phosphate enemas wɔ ayarefo a wɔanyinyin mu) ho >65 anaasɛ nea adwene no ayɛ basaa).
• Australia ne New Zealand:
• Ntɛmntɛm: Frɛ 000 (Australia) anaa ** .111** (New Zealand) na ɛwɔ hɔ.
• Residential Aged Care In-Reach / Community Nursing Triage: Wɔ Australia no, frɛ healthdirect wɔ 1800 022 222 anaa wo mpɔtam hɔ ayaresabea no Geriatric Rapid Evaluation and Treatment (GREAT) / Ayaresabea a ɛwɔ Fie (HITH) ayarehwɛfo kuw a wɔde wɔn ho kɔ baabiara; wɔ New Zealand no, di nkitaho wɔ Healthline wɔ 0800 611 116 anaa wo Ɔmantam Ayarehwɛfo som adwuma ma ofie disimpaction denam Microlax (sodium citrate/lauryl sulfoacetate) anaa Macrogol ( ) .Movicol) na ɛyɛ.
• India ne Asia-Pacific:
• Ntɛmntɛm: Frɛ 112 anaa ** .108** na ɛyɛ. Wɔ nkwakoraa ne mmerewa a wɔakɔ fie wɔ India nkurow akɛse mu fam no, ayaresabea ayarehwɛfo akuw a wɔhwɛ wɔn wɔ fie betumi ayɛ mpa ho nsu a wɔde fa nsu mu ne Nsu Paraffin / Ngodua Ngo a Wɔde Siesie Enemas a ɛyɛ brɛoo a wɔde Glycerin anaa Proctoclyss (sɛ adwene no dwumadi yɛ nea ɛfata nkutoo a; wɔpɛ nkyene/ngo a ɛyɛ hyew wɔ nkwakoraa ne mmerewa mu) enema, na wɔadan ɔyarefo no akɔ da biara da Polyethylene so Glycol ( ) .Pegmove / . Looz-PEG) anaa Lactulose ( .Duphalac) na ɛyɛ.

Nsɛm a wɔtaa bisa¶

Ɛbɛyɛ dɛn na m’awofo anya akisikuru kɛse bere a wɔrenya nsu mu akisikuru mpɛn 6 da biara no?¶

Wɔfrɛ saa tebea yi paradoxical overflow diarrhea (anaasɛ overflow incontinence), na ɛno ne ade a ɛtaa ma nsu a ɛyɛ nsu a ɛtwetwe mpofirim ba nkwakoraa ne mmerewa a wɔayɛ mmerɛw, wɔada mpa so, anaasɛ wɔde opioid ayɛ wɔn yare no mu. Sɛ nsu kɛse bi a nsu nnim (fecaloma) yɛ nea ɛyɛ mmerɛw te sɛ ɔbotan a ɛyɛ den wɔ akyi berɛmo no mu a, nsu a ɛyɛ den ntumi mfa mu bio. Mmoawa a ɛwɔ akyi berɛmo mu a ɛwɔ ade a wɔde asiw kwan no so no ma nwura a wɔakyere no yɛ nsu ma ɛbɛyɛ nsu bruu a ɛyɛ huam ne nsu a ɛyɛ fĩ, na ɛpiapia plug a ɛyɛ den te sɛ ɔbo no anoano na ɛtwetwe fi mu a wontumi nni so efisɛ ade kɛse no kura akyi berɛmo no mu ntini a ɛtrɛw no mu.

Dɛn nti na asiane wom sɛ wɔde Imodium (loperamide) anaa nnuru a ano yɛ den a wɔde sa anom bɛma obi a ne mfe akɔ anim a ne dwensɔtwaa a ɛboro so?¶

Sɛ wɔde aduru a ɛko tia akisikuru te sɛ Imodium (loperamide) ma ɔpanyin bi a ne dwensɔtwaa no retu atwa nsu a ɛwɔ nsu mu ho ahyia ankasa a, ɛma ntini a ɛwɔ akyi berɛmo no mu no yɛ mmerɛw, na ɛdan dwensɔtwaa no fã bi a asiw no ma ɛbɛyɛ dwensɔtwaa a esiw koraa a ɛde ne nkwa to asiane mu anaasɛ megacolon a awuduru wom. Nea ɛne eyi bɔ abira no, nnuru a ano yɛ den a ɛkanyan anom (te sɛ senna, bisacodyl nnuru, anaa magnesium citrate) a wɔde ma fi soro ansa na wɔaprapra akyi berɛmo no mu no hyɛ dwensɔtwaa a ɛwɔ soro no ma ɛtwetwe denneennen wɔ ɔbotan a entumi nkɔ baabiara so, na ebetumi abubu akyi berɛmo no fasu a atrɛw na mogya kɔm de no (stercoral perforation).

Dɛn nti na wɔabara Fleet (Sodium Phosphate) enemas a wɔtaa tɔ a wɔmfa nnuru nhyɛ mu mma mpanyimfo a wɔn mfe akɔ anim?¶

Nnurutɔnbea a wɔtaa de di dwuma Fleet enemas no kura hypertonic sodium phosphate. Sɛ obi a ne mfe akɔ anim a ɔyɛ mmerɛw, titiriw obi a n’asaabo ntumi nyɛ adwuma yiye, ne koma ntumi nyɛ adwuma yiye, ne nsu nnim, anaasɛ ne menewa a asiw a ɛkyere enema nsu no wɔ mu no nya sodium phosphate enema a, phosphate ne sodium no kɔ mogya no mu tẽẽ. Wɔ nnɔnhwerew kakraa bi mu no, ebetumi ama hyperphosphatemia a edi awu, mogya mu calcium a ɛso tew kɛse (a ɛma koma no gyaw na ɛyɛ tetany), ne asaabo a entumi nyɛ adwuma yiye daa. Fa Mineral Oil retention enema, tap-nsu a ɛyɛ hyew brɛoo anaa nkyene enema a ɛyɛ daa, Docusate (Enemeez) mini-enema, anaa glycerin/bisacodyl suppository di dwuma bere nyinaa.

Dɛn ne Stercoral Colitis, na bere bɛn na ɛsɛ sɛ mede m’awofo kɔ Ayaresabea ER ntɛm ara?¶

Stercoral colitis ba bere a nsu a ɛyɛ den te sɛ ɔbotan a ɛbɔ no mia akyi berɛmo no fasu so denneennen anaa sigmoid colon no fasu ho araa ma ɛtwa capillary mogya a ɛkɔ dwensɔtwaa no mu ntini no mu, na ɛde necrotic pressure akuru a emu dɔ ba wɔ akyi berɛmo no mu a ɛreyɛ atetew (stercoral perforation). Frɛ 911 na kɔ ayaresabea ER ntɛm ara, na womfa w’ano mma biribiara, sɛ ɔpanyin bi a ne ho ayɛ no yaw no yafunu mu yaw a emu yɛ den anaasɛ ɛyɛ kɛse, ne yafunu a ɛyɛ den anaasɛ ɛtrɛw, ɔfe, mogya a ɛba akyi berɛmo mu yɛ kɔkɔɔ anaa maroon a ɛyɛ hyew, atiridiinini, koma a ɛbɔ ntɛmntɛm, anaasɛ ɔbrɛ ne adwene a ɛyɛ basaa mpofirim a.

Dɛn nti na m’awofo gyaee sɛnea wotumi tow nsu bere koro no ara a wɔn nsu nyaa wɔn so nkɛntɛnso no?¶

Rectum ne bladder kɔn/urethra no tena wɔn ho wɔn ho so pɛɛ wɔ nnompe teateaa a ɛwɔ akyi no mu. Sɛ nsu a ɛyɛ den kɛse te sɛ ɔbo hyɛ akyi berɛmo no mu ma a, ɛpia kɔ n’anim na ɛde honam fam piapia nsu a ɛkɔ akyi ne akisikuru kwan a wɔatoto mu wɔ awotwaa mu dompe no ho no. Eyi ma nsu a ɛkɔ asaabo no mu yɛ den (akisikuru a ɛyɛ yaw na ɛyɛ ma dodo a ebetumi ama nsu a ɛtɔ gu fam nkutoo na akɔ soro na ɛma nhyɛso kɔ soro kɔ asaabo no mu), na ɛno nso kanyan ayaresabea mu adwenemhaw mpofirim wɔ nkwakoraa ne mmerewa mu. Mpɛn pii no, sɛ woyi rectal fecal impaction no fi hɔ a, ɛma wosan tow sɛnea ɛsɛ wɔ simma kakraa bi mu.

Dɛn nti na Colace (docusate) nnuru anaa Metamucil fiber a wɔde di dwuma da biara da no ansiw m’awofo fecal impaction ano?¶

Nsɔhwɛ ahorow a wɔayɛ wɔ ayaresabea no ada no adi mpɛn pii sɛ Docusate Sodium capsules (Colace) a wɔnom no ntumi nyɛ adwuma yiye nsen placebo a wɔde siw akisikuru ano anaasɛ wɔsa wɔ mpanyimfo a wɔn mfe akɔ anim anaa ayarefo a wɔnom opioid nnuru a wɔde kum ɛyaw no mu. Nea enye koraa no, nhama a wɔde yɛ nneɛma pii te sɛ Metamucil (psyllium) hia nsu pii da biara da na ama wɔatumi afa dwensɔtwaa no mu; wɔ ɔpanyin bi a ɔda mpa so a ɔnnom nsu pii anaasɛ ne dwensɔtwaa tumi tu brɛoo esiane opioid anaa Parkinson yare nti mu no, psyllium nhama yɛ den ma ɛbɛyɛ kɔnkrit wɔ ne dwensɔtwaa no mu na ɛde nsu a ɛkɔ ne mu no ba denneennen. Dan kɔ Polyethylene Glycol 3350 (MiraLAX) a wɔde ka Senna ho da biara da sɛ worenom opioids a.

Akwankyerɛ ahorow a ɛfa ho¶

• Adwene a ɛyɛ basaa mpofirim wɔ nkwakoraa ne mmerewa mu: UTI a ɛyɛ komm urosepsis vs. stroke ne nea enti a ayarefo a wɔn mfe akɔ anim nni atiridiinini
• Ayaresabea adwenemhaw ne aduruyɛ mu nsɛm a wɔka de kyerɛ nkwakoraa ne mmerewa
• Polypharmacy, nnuru a wɔnom boro so, dodow a wɔannye, ne mfomso a ɛwɔ pill organizer mu
• Parkinson ɔyarefo a ɔwɔ ayaresabea: nea enti a Sinemet/levodopa a wɔyera wɔ bere ano anaasɛ Haldol a wɔde ma no de kateeyɛ a edi awu ba

Fibea ne aban akwankyerɛ¶

• U.S. Aduan ne Nnuru Dwumadibea (FDA): FDA Nnuru Ahobammɔ Ho Nkitahodi: Kɔkɔbɔ a Ɛfa Asiane a Ɛntaa Nna Nanso Ɛyɛ Aniberesɛm a Ɛba sɛ Nsu a Ɛho Nsu, Adwene a Ɛnyɛ Yiye, ne Owu a Wɔde Sodium Phosphate Laxative/Enema Nneɛma a Wɔtɔn a Wɔtɔn wɔ Mpanyimfo a Wɔanyinyin Mu Ho.
• American Geriatrics Society (AGS): AGS Beers Criteria® a Wɔayɛ no Foforo a Ɛfa Nnuru a Ebetumi Afata a Wɔde Di Dwuma wɔ Mpanyimfo a Wɔanyinyin Mu (Sodium Phosphate Enemas, Anticholinergics, ne Opioids a Wɔmfa Nkosatia a Wonnye Stimulant/Osmotic Bowel Prophylaxis a Wɔkwati).
• American College of Gastroenterology (ACG) & American Gastroenterological Association (AGA): Ayaresa mu Adeyɛ Akwankyerɛ a ɛfa sɛnea Wɔhwɛ Idiopathic Constipation a Enni sabea, Opioid-Induced Constipation, ne Distal Fecal Impaction.
• UK National Institute for Health and Care Excellence (NICE) & Royal College of Nursing (RCN): NICE Ayaresabea Akwankyerɛ CG49 (Faecal Incontinence ne Faecal Loading/Impaction wɔ Mpanyimfo a Wɔanyinyin mu) & RCN Digital Rectal Nhwehwɛmu ne Nsa a Wɔde Yi Nsuo Akwankyerɛ.
• Wiase Fekuw a Ɛhwɛ Oprehyɛn a Ɛho Hia Ntɛmntɛm So (WSES): Ayaresabea Akwankyerɛ a Ɛfa Ntɛmntɛm Nhwehwɛmu ne Oprehyɛn/Aduruyɛ mu Nhwɛso a Ɛfa Stercoral Colitis ne Stercoral Perforation of the Colon Ho.