This digital breaking up and removal of impacted stool can potentially damage the mucous membrane linings in the bowel, and the stimulation to the vagus nerve that has endings in the rectum can cause heart irregularities. It is therefore a procedure that is undertaken only with extreme caution. Most often, nurses remove fecal impactions upon receiving a physician's order, or under a physician's supervision.
As gently as possible, the nurse inserts a gloved, lubricated index finger and massages around the edges of the impaction, gradually working the gloved finger into the mass to break it up. The broken-up pieces of stool are dislodged by carefully working them downward toward the end of the rectum. During this procedure, the patient should be checked regularly to assure that there are no untoward effects such as weakness, diaphoresis or clamminess, or changes in pulse rate.
The nurse positions the patient on his or her side, with knees flexed and back toward the nurse. A waterproof pad is placed under the patient's buttocks, and a bedpan to hold any removed stool is kept nearby. Occasionally, a patient will request to stand in the bathroom near the toilet during this procedure, but that is not advisable due to possible adverse reactions and the fact that this can be an exhausting process. The nurse then puts on rubber gloves and applies lubricant to the index finger that will be inserted to break up the impaction. Explanation of what is to be done, and reassurance that if the procedure is causing discomfort it will be stopped immediately, should be given before beginning.
Joan M. Schonbeck, The Gale Group Inc., Gale, Detroit,