Fecal impaction can occur as a result of extreme and severe constipation. Currently available treatments are not effective and are unpleasant. Thus, a study was conducted to assess the efficacy and safety profile of Movicol, a polyethylene glycol (PEG) and electrolyte solution (PEG+E) in the treatment of severe constipation and fecal impaction. The study cohort involved 56 patients (age: 17-88 years) with a history of chronic constipation and presented with no bowel movement for 3-4 days (severe constipation), or no bowel movement for at least 5 days (fecal impaction). Exclusion criteria was a gastrointestinal obstruction, evidence of delayed gastric emptying, or constipation secondary to severe inflammatory bowel disease. All participants were asked to take up to eight 13.8 g sachets of PEG+E (2 at a time in 250 ml water; maximum of 1L/day) over a 4-6 hour period each day, with 1-1.5 hour gap between each dosing. Duration of treatment was up to 3 days.

Patients were considered responders if there was either improvement (passage of a moderate to large volume of stool within 4 days of treatment initiation) or complete resolution (passage of moderate to large volumes of fecal matter along with disappearance of palpable fecal masses in the abdomen and/or rectum). Based on bowel movement data recorded by the patients, an excellent response rate was obtained. Out of 56, 50 patients showed a successful response to treatment (89.3%; 95% confidence intervals [CIs] 77.4% to 95.6%). Complete responders were 39 and 11 patients showed improvement. Moreover, investigator assessment of response was almost the same: 87.5% (95% CIs 75.3% to 94.4%). All bowel movement measurements including stool volume, number of evacuations, stool form and ease of evacuations showed a positive improvement by Day 2. Median duration of treatment was 2 days. None of the patients discontinued the study due to an adverse event. It was thus concluded that PEG+E, administered orally at a dose equivalent to eight 13.8 g sachets (1 L) per day over 3 days seems to be a highly effective and well tolerated therapy for managing severe constipation and fecal impaction.

Source: Curr Med Res Opin. 2005 Oct;21(10):1595-602.