Digital Disimpaction and How It's Done

Manual Relief of Severe Constipation

Digital disimpaction is the use of fingers to manually remove stool from the rectum. This may be done by a person with constipation or by a medical professional assisting someone with fecal impaction or conditions (like a spinal cord injury) that prevent defection.

For this procedure, a single finger of a gloved hand is lubricated and inserted into the rectum. The stool is gently broken up and removed in pieces until the rectum is cleared. Digital disimpaction can be performed on its own or in tandem with rectal irrigation (douching).

doctor putting on latex gloves
 Matt Lincoln/Getty Images


This article looks at the various reason why digital disimpaction may be needed and the possible risk involved with this manual procedure.

Also Known As

Digital disimpaction may also be called:

  • Digital removal of feces (DRF)
  • Disimpacting stool with digital maneuvers
  • Digital evacuation
  • Manual disimpaction
  • Manual elimination

Reasons for Digital Disimpaction

Digital disimpaction is not a recommended treatment for constipation unless the condition cannot be relieved by other methods or a person has a medical condition that significantly interferes with bowel movements.

Here are three reasons why digital disimpaction may be needed:

Fecal Impaction

Fecal impaction is a solid stool that is "stuck" in the rectum, typically as a result of chronic constipation. In addition to pain and bloating, fecal impaction can cause the overflow of diarrhea as fluids build behind the blockage. If left untreated, it can lead to ulcers, bleeding, and even tissue necrosis (death).

Causes and risk factors of fecal impaction include:

All of these conditions can lead to severe constipation by altering the consistency of stools and/or the normal contraction of the intestines.

Dyssynergic Defecation

People who experience chronic constipation due to a condition known as dyssynergic defecation are most likely to require digital evacuation.

Dyssynerigic defecation occurs when the nerves and muscles of the pelvic floor do not work together smoothly so as to produce a normal bowel movement. Essentially, the organs that facilitate a bowel movement are "out of sync."

Also known as anismus, dyssynergic defecation is considered a type of pelvic floor dysfunction. Since defecation requires the voluntary contractions of the anal sphincter, the condition generally stems from the inability to voluntarily control these muscles.

Causes include:

Biofeedback and physical therapy may also be recommended as a means to relax and better focus on anal sphincter control.

Spinal Cord Injuries

People with spinal cord injuries may need digital disimpaction as part of their daily bowel management. Manual disimpaction is considered a standard practice of care for people with severe injuries.

Motor vehicles accidents and severe falls are the most common cause of spinal cord injuries, but they can also be the result of a degenerative spinal condition or spinal tumors. The loss of bowel function may either be temporary or permanent.

Because a person with a spinal cord injury often has a loss of sensation around the anus and rectum, digital disimpaction should be performed by a healthcare professional (or a caretaker trained in the procedure) to avoid injury.

Recap

Digital disimpaction may be used to clear stool in people with fecal impaction, spinal cord injuries, or dyssynergic defecation (in which the muscles and nerves that help regulate bowel movements are impaired).

Risks and Considerations

It is not recommended that you use digital evacuation on a regular basis. You run the risk of injury, including anal fissures or rectal perforation, as well as hemorrhoids and infection. It can also cause the worsening of your condition if the anal sphincter is damaged.

In rare instances, fatal heart arrhythmias (irregular heartbeats) have been known to occur, most often in chronically ill older adults.

Your healthcare provider can do an assessment to figure out why your bowel movements are not normal. They will want to identify the underlying cause—whether it be a disease, structural defect, or obstruction—so that the appropriate short- and long-term solutions can be found.

Recap

Digital disimpaction, while useful, should not be used on a regular basis as it can lead to the worsening of your condition. It can also lead to rectal bleeding, hemorrhoids, infection, anal fissures, and rectal perforation.

Summary

Digital disimpaction is the removal of stool from the rectum using a gloved finger. It is used when a person is unable to pass stools due to severe constipation, fecal impaction, dyssynergic defecation, and spinal cord injuries.

Digital disimpaction may be performed by the person with constipation, a healthcare provider, or a caregiver trained in the procedure. It is sometimes used with rectal irrigation to gently clear the bowel.

Digital disimpaction is considered a short-term solution when all other reasonable options have failed. The regular use of digital disimpaction can cause hemorrhoids, anal fissures, rectal perforation, infection, and the worsening of defecation problems.

Frequently Asked Questions

  • When is digital disimpaction needed?

    Digital disimpaction is typically used when laxatives or enemas are unable to resolve fecal impaction. This includes people who cannot pass stools due to a spinal cord injury, older adults with dehydration, obese persons in traction, and people who experience impaction as a result of a barium enema.

  • Are there alternatives to digital disimpaction?

    A particular form of digital evacuation in women is called vaginal splinting. This involves massaging the inside of the vagina to encourage the passage of stool from the rectum. It may also help to massage the inside of the rectum or perineum in order to stimulate a bowel movement.

  • What other methods are used to treat fecal impaction?

    Prior to considering digital impaction, a healthcare provider will typically use enemas, osmotic laxatives, and polyethylene glycol to treat fecal impaction. Pulsed irrigation evacuation (PIE) is another method in which a person lies in bed while pulsating water gently breaks up and dislodges the fecal mass. Severe cases may require surgery.

Was this page helpful?
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Solomons J, Woodward S. Digital removal of faeces in the bowel management of patients with spinal cord injury: a reviewBritish Journal of Neuroscience Nursing. 2013;9(5):216-222. doi:10.12968/bjnn.2013.9.5.216

  2. Pepe J, Murphy MM, O'Connell KP, Zabbo CP. Fecal impaction with multisystem organ involvement. Clin Pract Cases Emerg Med, 2017 Mar;1(1):56-8. doi:10.5811/cpcem.2016.12.32754

  3. Pourmomeny AA, Emami MH, Amooshahi M, Adibi P. Comparing the efficacy of biofeedback and balloon-assisted training in the treatment of dyssynergic defecation. Can J Gastroenterol. 2011;25(2):89-92. doi:10.1155/2011/268062

  4. Sampson CS, Shea CM. Death by disimpaction: a bradycardic arrest secondary to rectal manipulation. Case Rep Emerg Med. 2016;2016:5489325. doi:10.1155/2016/5489325

  5. Rao SS. Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clin Gastroenterol Hepatol. 2010;8(11):910-9. doi:10.1016/j.cgh.2010.06.004

  6. Setya A, Mathew G, Cagir B. Fecal impaction. In: StatPearls [Internet].

  7. Abbott R, Ayres I, Hui E, Hui KK. Effect of perineal self-acupressure on constipation: a randomized controlled trial. J Gen Intern Med. 2015;30(4):434-9. doi:10.1007/s11606-014-3084-6