How Fecal Impaction Can Be Treated

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Fecal impaction (FI) is a state of prolonged constipation. It occurs when the stool is so hard that it cannot pass with a normal bowel movement. It causes abdominal discomfort, and rarely, can cause serious medical complications.

There are some risk factors, including a high-fat diet, immobility for a prolonged period of time, and psychological factors, but the condition can occur without an identifiable reason. FI can be treated with medication or with a procedure to remove the hard stool.

Woman in abdominal discomfort
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Fecal impaction usually causes abdominal discomfort similar to that of constipation, but typically with more severe intensity and for a longer period of time. You are likely to experience other symptoms in addition to constipation if you have FI, and the symptoms tend to worsen the longer you go without having a bowel movement.

Symptoms of fecal impaction include:

  • Abdominal cramping
  • Abdominal discomfort
  • Abdominal pain
  • Abdominal distension
  • Fecal soiling
  • Loss of appetite
  • Back pain
  • Nausea
  • Vomiting
  • Bad breath
  • Hemorrhoids (enlarged rectal blood vessels)


In rare cases, untreated fecal impaction can result in serious health complications, such as bowel ulceration, perforation, thrombosed hemorrhoids (a blood clot in a rectal blood vessel), a gastrointestinal infection, or peritonitis (an infection that spreads outside the gastrointestinal system).

If these complications occur, symptoms can include fevers, chills, rectal bleeding, low blood pressure, rapid heart rate, dizziness, or loss of consciousness.


Fecal impaction typically occurs when a person has not had a bowel movement for many days. There are several common lifestyle risk factors that increase the chances of having FI. Some illnesses can make you prone to the condition, and certain populations are at higher risk.

Common lifestyle risk factors for FI may include:

  • Lack of fiber in the diet
  • High-fat diet
  • Not eating or drinking enough, dehydration
  • Lack of access to a toilet, due to traveling or other circumstances
  • Excessive stress
  • Reluctance to have a bowel movement

Medical conditions that increase the risk of FI include:

  • Neurological impairment
  • Extended periods of physical immobility
  • Inability to eat or drink
  • Post-surgical bowel dysfunction
  • Bowel obstruction (blockage)
  • Thyroid disease
  • Medication side effects

Some populations that are at a higher risk of fecal impaction include:

  • Older adults residing in nursing homes who have minimal or no physical activity
  • Individuals with neurological conditions that can impair bowel mobility, such as Alzheimer's disease, Parkinson's disease, dementia, spinal cord injury, or stroke
  • Children, particularly those who avoid having a bowel movement out of anxiety, embarrassment, or to avoid pain
  • People taking medications that produce the side effect of constipation, such as some antihypertensive medications, antidepressants, and muscle relaxers
  • Individuals who take narcotics, the category of medication most closely associated with constipation, which may cause a condition known as narcotic bowel syndrome
  • People who overuse or abuse laxatives (stool softeners), which can have a paradoxical effect on the colon, making it unable to function normally
  • Individuals who have structural and functional conditions involving the small intestine, colon, or rectum, due to gastrointestinal disease, cancer, or surgery


There are many causes of abdominal pain and cramping, and fecal impaction may not be the obvious cause of your symptoms at first. Your healthcare provider will diagnose you based on your medical history, physical examination, and possibly, diagnostic tests as well.

  • Medical history: If you complain of recent constipation and decreased bowel movements, or if you have had fecal impaction in the past, this raises suspicion that you could have fecal impaction.
  • Physical examination: Your physical examination may reveal that you have a hard abdomen, that you have pain or tenderness when your healthcare provider presses on your abdomen, or that your abdomen appears distended (swollen or larger than usual).
  • Imaging: Diagnostic imaging tests may be done to confirm the diagnosis. An abdominal plain film X-ray would show if the colon is full of stool. Sigmoidoscopy is an invasive test involving the insertion of a small camera into the rectum to view the inner colon.


Fecal impaction can be treated with medication and may require a procedural intervention for particularly resistant situations. The best method of treatment depends on whether your healthcare providers have diagnosed a recent fecal impaction or a fecal impaction that has lasted for days or longer.

Your best method of treatment also depends on whether there is one area or multiple areas of impaction, where they are located within your colon, and whether the stool is very hardened or difficult to soften with medication.


The first line of treatment involves the use of laxatives, which are typically oral medications that soften the hardened stool so that it can be passed. If you do not regularly use laxative medications, they should be effective relatively quickly.

You can expect to have at least one, if not more, large bowel movements within a few hours after using a laxative, and possibly for the next several days. It is best to remain where you can easily get to a toilet. However, this may not be a suitable treatment for some older people.

Sometimes a laxative is used as a suppository, meaning that it is taken in a form that is inserted into the rectum, rather than taken by mouth. This should work more quickly than an oral laxative and is a preferred method if the impaction is particularly distal (low down) in the colon.


There are also treatments that more actively remove the stool:

  • Enema: An enema is a treatment in which a liquid is injected into the rectum. Your healthcare provider or nurse may inject the liquid using a nozzle or may give you instructions to use an enema at home. The liquid material contains ingredients that soften the stool so you can have a bowel movement.
  • Water irrigation: With this method, your healthcare provider gently inserts a tube that injects water into the rectum to loosen the stool, allowing you to have a bowel movement.
  • Manual procedure: In severe cases, the blockage may need to be manually removed with a procedure. Your healthcare provider would gently locate the area or areas of fecal impaction by feeling the outside of your abdomen and would carefully place a gloved finger into the rectum to relieve the obstruction.


If you or a loved one is at risk of developing fecal impaction, preventative strategies are essential. Increasing your dietary fiber intake and water consumption can be very helpful.

Depending on your medical condition, your healthcare provider may recommend that you regularly use stool softeners or laxatives to prevent constipation. This decision has to be weighed carefully because laxatives can make your colon less responsive and functional than normal.

Your healthcare provider also may make changes to any of your medications that are contributing to constipation. If you have had neurological damage or intestinal surgery, bowel retraining exercises may also be recommended.

A Word From Verywell

You should let your healthcare provider know if you experience pain caused by constipation, or if you have not been able to have a bowel movement for several days. These problems can be treated more easily in the early stages, and treatment can prevent serious complications from occurring.

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