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Faecal Impaction OIC — SCE Medical Oncology MCQ

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EasySupportive & Palliative OncologyFaecal Impaction OICSCE Medical Oncology

A 65-year-old man with cancer develops severe constipation refractory to maximum oral laxatives. He is on morphine modified-release 90 mg BD. Digital rectal examination confirms hard impacted stool. What is the stepwise management of opioid-induced constipation with faecal impaction?

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Correct answer: C — Stepwise: (1) suppositories (glycerine/bisacodyl) and micro-enema for rectal impaction, (2) manual evacuation if needed, (3) phosphate enema for higher impaction, (4) optimise laxative regimen (stimulant + osmotic), (5) if refractory to conventional laxatives, add a PAMORA (methylnaltrexone/naloxegol)

Faecal impaction requires a bottom-up approach: rectal impaction is treated with suppositories (glycerine ± bisacodyl) and micro-enema first, progressing to phosphate enema for higher impaction. Manual evacuation under sedation may be needed for hard rectal impaction. Once cleared, prophylactic laxative regimen should be optimised (stimulant + softener). Refractory OIC despite adequate conventional laxatives warrants a PAMORA (methylnaltrexone SC or naloxegol PO) which blocks peripheral opioid receptors without affecting central analgesia.

Reference: NICE CG140 Opioids in palliative care; BNF; ESMO Supportive Care