GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 266

Figure 19-1. Digital removal of a fecal impaction
Although breaking up and extracting a fecal impaction is aesthetically unpleasant, no
alternative exists. Enema fluids will not enter the solidified fecal mass; laxatives have no
effect on the dilated, flaccid rectal wall. Paradoxically, fecal impaction may be accompan-
ied by the passage of a number of small, watery stools—the only material that can get past
the impacted mass.
Anal Fissure
With constipation the stool may become so hard and bulky that its passage causes a
small tear (fissure) in the skin of the anus. Subsequent bowel movements are painful and
may be associated with a small amount of bleeding.
Avoiding hard, constipated stools by consuming adequate water often allows the fissure
to heal. A temporary low-residue diet that is low in fiber and consists of foods that are
almost totally absorbed, such as milk, soups, and carbohydrates, may avert bowel move-
ments for several days and allow healing, although this diet may be constipating. Strain-
ing at stool should be avoided indefinitely. Supporting the body so its full weight is not
on the toilet seat during defecation avoids aggravating the injury. The anal area should be
cleaned gently after each bowel movement. Aggressive wiping (particularly with coarse
paper), scratching, and rubbing should be avoided.
Mineral oil, one tablespoonful (15 ml) twice a day, lubricates the stool and reduces the
painwithbowelmovements(mineraloilisnotalaxative—onlyalubricant).Ifpainpersists
between bowel movements, a bland anesthetic jelly such as 1 to 2 percent lidocaine may
be applied. The jelly or a rectal suppository may have to be inserted into the anal canal.
Healing may also be aided by the application of 1 percent hydrocortisone ointment.
Persistent pain or bleeding should be brought to the attention of a physician as soon as
possible.
Hemorrhoids