Digital disimpaction, also referred to as digital fecal evacuation, manual fecal removal, manual evacuation, or rectal clear is probably one of the most uncomfortable procedures for patients and one of the least favored tasks of medical providers. Removing impacted feces is embarrassing for both parties and one of the few procedures that is difficult to make completely comfortable for anyone. However, as a medical professional, you are a trusted care provider and you do have the ability to make the procedure less traumatic and help your patients find much-deserved relief.
What Digital Disimpaction is and Why It May Need to Be Done
Digital disimpaction is the medical procedure of using gloved (and lubricated) fingers to manually remove feces from the rectum of a patient. Although this is not a procedure that all patients require and a nurse or provider may go months without completing manual evacuation on a patient, there are some circumstances that make it more likely. For instance, those who have suffered a spinal injury and have non-reflex bowel, neurogenic bowel dysfunction, or those who suffer from chronic constipation and become impacted where oral laxatives or suppositories do not provide results. For those with chronic constipation or opioid-induced impaction, other methods of relief should be attempted prior to completing digital disimpaction.
For more information or to obtain the list of steps on performing the procedure, please refer to your facility policy manual. For the safety of the patient, ensure that you have all the information you need regarding the patient’s condition and a baseline blood pressure prior to beginning the procedure. In today’s post, we will simply be discussing ways you can make your patient more comfortable during the procedure.
Make the environment comfortable.
There is nothing you can do to change the procedure that is about to take place, but you can help ease anxieties and make the environment more comfortable by implementing a few comfort measures. If you are able to, attempt to dim the lighting so that your patient does not feel like they are on display. Warm the room to a comfortable temperature that will allow your patient to relax when exposed. Ensure that blinds or curtains are closed and clear the room of additional people. The door should also be closed to ensure maximal privacy.
Protect the dignity of your patient.
During any rectal procedure, your patient is likely to feel vulnerable and exposed. While you have to expose the buttocks and rectum, you can protect the patient’s dignity by allowing them to wear as much clothing as they are comfortable with and covering as much of their body with a blanket that you can. As mentioned previously, ensure that privacy is respected by clearing the room and closing doors and blinds.
Manage your facial reactions.
When you walk into the patient’s room and when talking to them, be sure to maintain a neutral or smiling face and tone. Avoid making faces that show any disgust or reaction to foul smells. If necessary (and we recommend it), wear a surgical mask to reduce smell exposure, risk of contamination, and to help hide facial expression. Inside your mask, you can chew gum or apply minty chapstick to help reduce the impact of odors. Indicating with facial expressions that you are uncomfortable will undoubtedly make your patient extremely uncomfortable, embarrassed, and will break their trust and confidence in you as a professional.
Talk to your patient.
There is nothing that can put someone at ease like talking. Talk to your patient about the procedure and what to anticipate and then talk to them throughout the procedure. Make small talk, and engage them in conversation. The more lighthearted the conversation, the more it helps put everyone at ease and create a comfortable atmosphere.
Be as quick and gentle as possible.
Do not stall or take longer than necessary while removing stool. However, your haste should not come at the cost of being rushed and therefore rough. Remember that impaction is already uncomfortable and likely causing pain to your patient and the rectal tissue is sensitive. The hard stool can easily cause damage to the bowel and scraping it out without being gentle can easily cause a lot of damage. Be swift, yet gentle, and be thorough.
Be liberal with the lubricant.
This is no time to be conservative with your use of lubricating jelly. If you are using individual Foilpacs®, it is perfectly acceptable to use more than one, reapply as needed, or opt for the 5-gram pack as opposed to the 3-gram pack. The medical lube will not only help your fingers glide smoother in the cavity, but will also help soften the fecal matter. Be sure to use a water-based lubricant like Surgilube® surgical lubricant to provide premium viscosity and easy cleanup.
If done correctly and with some intentional thought to patient comfort, you can successfully manual evacuate your patient’s bowels without causing excessive discomfort, embarrassment, or feelings of vulnerability. At HR Pharmaceuticals, we have been creating high-quality medical lubricants that have helped ensure patient safety and comfort for more than 80 years. We are the name that healthcare providers around the world trust and we are proud to offer confidence and comfort to medical professionals and patients alike.