Hello, My Father Is Hypertention And Diebetic XXXXXXX Patient, Recently

Brief Answer:
A second enema with warm water and mineral oils might be tried, if no success, digital removal is needed

Detailed Answer:
Hello and welcome at "Ask a Doctor" service.

Your father is having what we call stool impaction. This may be due to chronic constipation and also diabetes might affect the nerves of the gastrointestinal tract and cause problems with bowel movement.

First the doctor will need to rule out bowel perforation so having an abdominal xray might be the first step if perforation is suspected, then he can go on with the rest of the treatment as explained below:

At the moment he needs to remove that stuck hard stool. This is first tried with enema. If the first enema did not work, it might be a good idea to have the second one (warm water enemas with mineral oils are the most recommended ones).
If the second enema is not working then physical removal of bits and pieces of the hard stool is recommended (digital removal). While the lower part of the bowel is emptied oral polyethylene glycol (PEG) can be given daily to prevent the development of the fecal impaction in the future.
If the mineral oil enema and the digital removal of pieces are not able to relieve the impaction, sometimes it is a need to do local anesthesia on the patient to relax the rectal muscles and do a colonoscopy to remove the impacted stools.

It is very important that fecal impaction is treated promptly especially in elderly because it may get complicated with serious conditions like bowel perforation.

Once stool impaction is treated he will need to get good control of constipation to prevent this from happening again. Some laxatives (medications for constipation) are not good because they make the bowel lazy and increase the risk for fecal impaction so he should avoid bowel stimulants (senna or bisacodyl) and can safely use fiber (that he is already using) and polyethylene glycol (this is the most recommended one).
Taking plenty of water during the day, trying to be active and having fruit and vegetables in diet are also important. He should use polyethylene glycol daily for a long time.

A good control of diabetes is important as well.
There is not much information on the medications your father is using but he will need to discuss with his doctor the medications he uses and see if there is a relation to severe constipation with any of the medications and if any adjustment is possible to help with this.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Antoneta Zotaj,
General & Family Physician

---