Manual disimpaction is a procedure for the relief of
constipation that has become so severe that the
feces is
impacted in the lower colon and rectum to such a degree that it cannot be evacuated by regular pressure or with the aid of
laxatives,
suppositories, or
enemas.
While some people with spinal cord injuries are taught how to perform manual disimpaction on themselves, the procedure is usually performed by a health care practitioner1. The patient is placed on his or her side with knees bent; the practitioner may suggest that the patient focus on taking deep, regular breaths. After a minimum of one latex glove has been placed on the hand that will execute the procedure, a significant amount of lubricant will be used to cover the anal region of the patient and the index and middle fingers of the practitioner. Placing one hand on the patient's side or shoulder for patient reassurance and practitioner stabilization may make the procedure a little less awkward for everyone involved. The practitioner will then insert one or two fingers through the anus and into the lower rectum, where the impacted stool is generally lodged. Various rotational hand movements may be required to disimpact the fecal material and remove it from the rectum. After the procedure, the patient usually experiences immediate relief and may be able to empty the remaining contents of the bowels.
Prior to performing a manual disimpaction, it is necessary to rule out the possibility of a physical obstruction in the colon (such as a tumor or a rectocele).
1 This procedure has been crassly referred to as "finger of medical student", "hand of intern", or any other combination of words that would suggest that the lowliest practitioner in the healthcare team will be the one to execute the disimpaction.