Overview of Fecal Impaction

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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. There are some risk factors, including a high-fat diet, immobility for a prolonged period of time, and psychological factors, but it can occur without an identifiable reason. It causes abdominal discomfort, and rarely, can cause serious medical complications. FI can be treated with medication or with a procedure to remove the hard stool.

Symptoms 

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:

Complications

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.

Causes

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 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:

  • Elderly 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 of 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

Diagnosis

There are many causes of abdominal pain and cramping, and fecal impaction may not be the obvious cause of your symptoms at first. Your doctor 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 doctor presses on your abdomen, or that your abdomen appears distended (swollen or larger than usual).
  • Diagnostic tests: You may need diagnostic tests to confirm the diagnosis. The most common test is an abdominal X-ray with barium. This test, called a barium enema, begins with your doctor inserting liquid barium into the rectum. The way this agent shows up on your X-ray can reveal areas of blockage to help identify a fecal impaction. An abdominal ultrasound is another common imaging test that allows your doctors to view your stomach and intestines from many angles during the examination. And an invasive test, called a sigmoidoscopy, involves insertion of a small camera into the rectum to view the inner area of the colon.

    Treatment 

    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 doctors 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.

    • Oral laxatives: 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 as well. It is best to remain where you can easily get to a toilet right after you take a laxative and for a few days afterward.
    • Suppositories: 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.
    • Enema: An enema is a treatment in which a liquid is injected into the rectum. Your doctor 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 doctor 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 doctor 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.

    Prevention 

    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 physician 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 doctor 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 doctor 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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