We do manual (sticking fingers where fingers normally don't go) disimpaction when a patient has a rectum and lower bowel full of hard, dried feces that they can't excrete. Using lots and lots of lubricant and a gentle touch will help, but you can't get around the fact that you're ouching somebody who's already ouched out.
It should be avoided at all costs, and not just because it lacks dignity.
They help the patient get rid of whatever's up there, plus, they leave the intestine relatively clean in the process.My personal favorite is 750 ml normal saline warmed in a graduated cylinder in the microwave, with the remaining room-temperature saline added until the temperature is comfortable.You can easily traumatize delicate tissue while doing a manual disimpaction.And, frankly, if a patient gets *that* impacted while in the hospital, somebody isn't doing their job. Probably more than you wanted to know, but at least a bit helpful for the new nurse or student.Stuff Softeners won't work for a patient who has pre-existing problems with constipation or who's badly impacted. It's good for the moderately-constipated patient with no huge health problems (the usual neurosurgery candidate, in other words).
I've never had a lot of success with prune juice, even warmed, unless it's with people who've been using it for years as a laxative.In most hospitals in the US, poop is the nurses' purview. In short, we deal with a lot of constipated patients a lot of the time. It's an ugly fact of life, but it's true: if you have a patient who's undergone brain/cardiac/leg/facial surgery (anything, practically, short of surgery for an intestinal obstruction or ileus), it is your responsibility as a nurse to make sure that they're regularly moving their bowels. Sometimes the lower intestine itself gets lazy, and then you have the dual problem of dry Stuff and Lazy Bowel.Both will send your patient into low-earth orbit if they're not terribly backed up, and will cause hemorrhoids if they are.I use the pills as a last resort and the suppositories as a next-to-last resort.Even a mineral oil enema to loosen things up and grease them along is preferable to the trauma of disimpaction. Enjoy your day, eat your salad, and for heaven's sake, don't let your patient go more than 36 hours without a tour of the porcelain empire.