Digital Disimpaction and How It's Done

Digital disimpaction is the use of fingers to manually remove stool from the rectum. This may be done by a person with constipation or by a medical professional assisting someone with fecal impaction or conditions (like a spinal cord injury) that prevent defecation.

Digital disimpaction is used when laxatives or enemas are unable to resolve fecal impaction. 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.

This article explains how digital disimpaction is done and the cases in which it's most often helpful. It also discusses the risks, as well as offering some alternatives to digital disimpaction.

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.

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 (tissue bulges between the vagina and rectum, with symptoms affecting either)
• 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 vehicle 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 lesions and tumors.

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.

How to Perform Digital Disimpaction

A digital disimpaction is usually done daily or every other day, depending on the individual. The first step is to gather needed supplies, including:

• Soap, washcloth, and towel (Have a water source, too.)
• Lubricant
• Toilet paper and a plastic bag to throw waste in
• Toilet seat, commode, or shower chair preparation
• Underpads if done for someone who remains in bed

Sterile gloves are key to personal hygiene and avoiding infection, and should be changed after use. The next steps of a digital disimpaction are as follows:

1. Have the person lie on the left side if not using a toilet or chair seat.
2. Apply lubricant to the finger you'll insert into the rectum (make sure both hands are washed and gloved).
3. Insert a finger into the rectum, until you feel stool.
4. Gently remove any fecal matter, repeating the process until there's no more stool.
5. Wipe the area with toilet paper and then clean with soap and water.

Flush or throw away the waste when you're done and be sure to wash hands again. Keep in mind that the digital disimpaction should only be done by a properly trained provider or caregiver.

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 worsen 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 identify the underlying cause—whether it be a disease, structural defect, or obstruction—in order to determine the appropriate short- and long-term solutions.

Alternative Treatments

Prior to considering digital impaction, a healthcare provider will typically use enemas, osmotic laxatives, and polyethylene glycol to treat fecal impaction. The polyethylene glycol, followed by lactulose, are preferred methods in children.

Pulsed irrigation evacuation (PIE) is a method in which a person lies in bed while pulsating water gently breaks up and dislodges the fecal mass. It can be used with a balloon attachment that creates a seal when a speculum is inserted into the rectum, allowing water to stay in for a short time. It also is used to remove fecal matter ahead of a colonoscopy.

A particular form of digital evacuation in women is called vaginal splinting. This involves massaging the inside of the vagina to encourage the passage of stool from the rectum. It may also help to massage the inside of the rectum or perineum in order to stimulate a bowel movement.

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.