Fecal impaction refers to the formation of hard, dry stool that is difficult to excrete naturally. It’s more serious than constipation. People who experience constipation are at increased risk of fecal impaction.
If fecal impaction occurs, treatment is usually required to allow the stool to pass. Treatment may include medications, enemas, procedures, or a combination thereof.
There are several risk factors for fecal impaction. However, even if an individual experiences multiple risk factors, they can still take some precautions to prevent the condition.
cause
Fecal impaction usually occurs when a person does not have a bowel movement for several days. Several lifestyle factors and medical conditions increase the risk of fecal impaction. Some people, especially older adults in nursing homes, are at the highest risk.
Lifestyle risk factors include:
Lack of fiber, immobility, dehydration, not drinking enough
Medical conditions that increase risk include:
Structural diseases of the colon and anus (e.g., megacolon) Previous surgical interventions of the anus and colon Neurological diseases (e.g., Parkinson’s disease, multiple sclerosis, Alzheimer’s disease) Metabolic diseases (e.g., hypothyroidism or high calcium drug side effects (e.g., opioids), tricyclic antidepressants, anticholinergic drugs) spinal cord injury
Older adults are most at risk of developing fecal impaction. Up to 50% of older adults in long-term care facilities (such as nursing homes) experience fecal impaction over the course of a year. Additionally, children and individuals with neuropsychiatric disorders are also at increased risk of developing fecal impaction.
symptoms
Fecal impaction usually causes abdominal discomfort similar to constipation, but is more intense and lasts longer. Unlike constipation, where stool is difficult to pass, fecal impaction occurs when the stool becomes too hard to pass without intervention. Fecal impaction can be a complication of constipation.
Other symptoms besides constipation may occur. Symptoms usually get worse the longer you go without a bowel movement.
When fecal impaction occurs, the following symptoms may occur:
Abdominal pain Abdominal discomfort Abdominal pain Bloating Stool stains Loss of appetite Back pain Nausea Vomiting Rectal bleeding Straining to defecate Back pain Loss of bladder control or leakage Excitement
complications
Fecal impaction can cause several complications, including but not limited to:
Colon ulcers due to increased stool pressure Colitis Bowel perforation Pulmonary aspiration Rectovaginal fistula (abnormal connection between the rectum and vagina, allowing stool to enter the vagina) Urinary retention Megacolon Colonic perforation Peritonitis
In severe cases, fecal impaction can cause colonic perforation and subsequent peritonitis, which can become a medical emergency. A hole in the colon can cause stool to leak into the abdomen, causing serious infection.
diagnosis
There are many different causes of abdominal pain and cramps. Fecal impaction may not be the obvious cause of symptoms at first. Initially, symptoms may resemble those of a bowel obstruction.
Your health care provider will diagnose your condition based on your medical history, physical exam, and, if necessary, diagnostic tests.
Medical history: Your health care provider may suspect fecal impaction due to the presence of some symptoms, a recent history of constipation, decreased bowel movements, or a history of fecal impaction. Physical Examination: Physical examination may reveal a firm abdomen. Your abdomen is painful or tender when a health care worker presses on it, or your abdomen appears bulging (swollen or larger than normal).Imaging tests: Your health care provider may evaluate the extent of fecal impaction through imaging tests, such as serial abdominal tests or a CT scan.
process
Treatment of fecal impaction includes drugs to soften the stool and encourage defecation, as well as enemas, digital dissection, other treatments, and, in severe cases, surgery.
Most mild to moderate cases of fecal impaction can be treated with drug therapy. However, procedures such as digital dissection or surgical intervention may be necessary. Treatment depends on how hard your stool is, whether other complications are occurring, and the severity of your symptoms.
laxative
Your health care provider may recommend laxatives first. These drugs are usually taken by mouth to soften hard stools so they can be passed. If you don’t use laxatives regularly, you should see results relatively quickly.
One example of a laxative recommended to help move fecal impaction is MiraLAX, a polyethylene glycol. MiraLAX is considered an osmotic laxative, meaning it draws water into the intestines to soften stool.
After using a laxative, you can expect to have at least one bowel movement, or more, within a few hours and sometimes for several days afterwards. It’s best to stay where you can quickly go to the bathroom. However, this may not be an appropriate treatment for some older people.
In some cases, laxatives may be used as suppositories. This means that it is inserted into the rectum rather than taken orally. This should work faster than oral laxatives.
procedure
There is also a fecal impaction treatment that removes feces more aggressively.
Enema: An enema is a treatment that involves injecting liquid into the rectum. Your health care professional or nurse may inject you with liquids or give you instructions on how to use an enema at home. The liquid contains ingredients that soften stools, making them easier to pass. Water irrigation: In this method, your health care provider gently inserts a tube that injects water into your rectum to loosen the stool and allow it to pass. Oral or nasogastric tube: One of these tubes is placed so that your health care provider can administer a polyethylene glycol solution containing electrolytes. Polyethylene glycol is a laxative that softens stool and aids in defecation. Manual action: In severe cases, the blockage may need to be removed manually. The health care worker carefully identifies the area where fecal impaction has accumulated by feeling the outside of the abdomen and carefully inserting a gloved finger into the rectum to relieve the obstruction.
Emergency fecal impaction surgery may be needed if there is a complete intestinal obstruction or if the colon is abnormally dilated (megacolon), but these cases are rare.
prevention
Up to 39% of people who experience fecal impaction will have symptoms again, so prevention is essential.
Once the fecal impaction has resolved, your health care provider may perform a colon evaluation. The evaluation will show if there are structural abnormalities, strictures, or in rare cases, cancer.
Some basic measures can help prevent fecal impaction, such as moving daily if possible, increasing your fluid intake, and increasing your daily fiber intake. It is also essential that individuals have easy access to the toilet whenever they need it.
Depending on your medical condition, your health care provider may recommend regular use of stool softeners or other medications to soften your stool and make it easier to pass.
Your health care provider may also test for hypothyroidism (a frequent medical cause of constipation) or change the medications that are causing your constipation.
summary
Fecal impaction is a common and unpleasant condition most often seen in older adults. It can often be prevented with adequate fiber intake, daily exercise, and drinking plenty of water.
However, in some cases, underlying drug conditions may predispose people to fecal impaction (eg, in patients who are bedridden or who require drugs that make them more likely to become constipated).
Let your health care provider know if you have pain from constipation or if you haven’t had a bowel movement for several days. These problems are easier to treat in their early stages, and early treatment can prevent serious complications.