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Manual removal of a fecaloma

Set of activities performed by the nurse to remove the abnormal accumulation of fecal matter that forms a hardened mass in the lower portion of the bowel.


– Reestablish the patient’s usual intestinal transit. – Promote fecal elimination. – Relieve discomfort caused by fecal impaction.


– Genital hygiene equipment.


– Genital hygiene material. – Water-soluble anesthetic lubricant. – Soaker. – Non-sterile disposable gloves. – Nursing records.


– Perform hand washing. – Prepare the material and move it to the patient’s room. – Preserve the patient’s privacy. – Inform the patient. – Request the collaboration of the patient and family. – Protect the bed with the soaker. – Place the patient in the left Sims position and bring the wedge close to the patient. – Put on gloves. – Empty 1-2 cannulas of water-soluble anesthetic lubricant into the patient’s rectal ampoule and wait about 10 minutes for it to take effect. – Lubricate the index finger. – Ask the patient to take deep breaths to relax. – Instruct the patient to defecate and insert the finger into the rectum (towards the umbilicus). – Remove fecalomas by finger movements, if they are excessively large, do not attempt to remove them without first fragmenting them manually. – Ask for the patient’s cooperation by asking him/her to make efforts so that the fecalomas come down from the rectal ampulla. – Perform genital hygiene. – Place the patient in an appropriate position. – Collect the material. – Remove gloves. – Perform hand washing. – Record in the nursing documentation: procedure, reason, date and time, incidences and patient’s response.


– After fecaloma removal, watch for possible recurrent bleeding. – The procedure should be suspended in the event of bleeding, pain or vagal reaction. – After fecaloma removal, it is advisable to administer a 250 cc enema to clean the rectal ampulla.

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