Faecal loading
Stercoral colitis and Stercoral ulcer
Due to Severe prolonged constipation
Ulcer of the colon
Management of slow-transit chronic constipation
First,
Evaluate for secondary cause (eg, hypothyroidism) & medications causing constipation (eg, tricyclic antidepressants, certain antihypertensives) and treat appropriately.
If no salient cause, then ⇒ Increase dietary fiber to 20-35 g/day
No improvement? ⇒ Start bulk-forming laxative (eg, psylilium, methylcellulose, polycarbophil) - safe and effective for most pts
No improvement? ⇒ Consider osmotic agents (eg, polyethylene glycol, lactulose, sorbitol); ⇒ Consider stimulants (eg, bisacodyl, senna); N.B. Osmotic and stimulant laxatives can lead to electrolyte abnormalities (eg, hypokalemia) with long-term use ⇒ Also consider saline laxatives (eg, magnesium citrate, MoM)* *avoid in CKD due to hypermagnesemia
Still No response? ⇒ Consider chloride channel activators (eg, Lubiprostone)
And, finally, ⇒ Consider colectomy/hemicolectomy for severe cases