Fecal impaction Quiz: Ace Your Exams

A 74-year-old woman is on an inpatient medicine unit after undergoing surgery for a left hip fracture 5 days ago. Her postoperative pain has been difficult to manage, and she has required significant amounts of narcotic pain medication. The patient notes that she feels bloated and has not had a solid bowel movement since admission. She states she does not have much of an appetite but she has not had nausea or vomiting and can still pass flatus. Temperature is 37.1°C (98.8), blood pressure is 123/77, pulse is 76/min, respiratory rate is 15/min, and oxygen saturation is 97% on room air. On physical examination, her abdomen is soft but distended, mildly tender to deep palpation, and without rebound tenderness or guarding. On digital rectal examination, a bulky and hard mass of stool is palpated in the rectum. Bedside abdominal X-ray confirms a large colonic stool burden. After performing a successful manual disimpaction, which of the following is the best next step in management?