Fecal impaction is a severe form of constipation in which a large mass of stool cannot be passed.
This condition occurs most commonly in the older people, although it can be seen at any age. Usually, the person has severe constipation for several days before developing symptoms. Some of the stool may become quite hard and block the intestines, so that other stool cannot be pushed out. Most often, the blockage occurs close to the anus.
Each of the following symptoms generally gets worse the longer the condition goes untreated: constipationswelling of the abdomennausea and vomitingthin watery discharge from the rectumabdominal distress or crampingfever
Fecal impaction occurs in elderly or bedridden persons who become constipated over a long period of time because of dehydration or the inconvenience of using the toilet. It can also occur in children who refuse to pass stool. Rectal disorders such as painful hemorrhoids can also cause fecal impaction. Individuals who use laxatives too often may develop impaction when they stop taking them. A person whose diet doesn't include enough fiber or fluid is at risk for fecal impaction.
Fecal impaction can be prevented by eating a normal, well-balanced diet following the Food Guide Pyramid. This includes foods that are high in fiber as well as a fluid intake of at least 6 to 8 glasses per day. The urge to have a bowel movement should not be put off. Persons with chronic constipation are often given stool softeners, such as docusate, or enemas to prevent this problem.
Often, the healthcare provider can push on the abdomen and feel the enlarged intestines that are full of stool. An abdominal x-ray may be taken to confirm the diagnosis. Obstruction of the bowel can occur for different reasons, so the bowel is usually emptied with an enema or laxative first. Then, a barium enema is done to look at the inside of the bowel. This test can show whether there is a growth or inflammation causing an obstruction.
Fecal impaction usually has no long-term effects. However, it may happen repeatedly unless the underlying cause is corrected. If an impaction happens often, the colon may be damaged or an infection may occur.
There are no risks to others.
The bowel needs to be emptied. Often, the impaction may be fixed by inserting a lubricated finger into the anus and breaking up the hardened stool. Other times, an enema or laxative is required to get the stool to move. Sometimes antibiotics are needed if an infection develops. Very rarely, part of the bowel may need to be removed with surgery.
Enemas and laxatives can cause dehydration and salt imbalances in the body. However, they are usually well tolerated.
A person with a fecal impaction usually recovers quickly.
After fecal impaction, a person needs to be monitored closely to make sure the impaction does not recur. A diet high in fiber, increased fluid intake, stool softeners, and enemas may all be advised.
Principles of Surgery, 1999, Schwartz et al. Textbook of Surgery, 1997, Sabiston et al