Fecal Impaction What is a Fecal Impaction?

Fecal impaction is a mass of dry, hard stool that can't be eliminated by a normal bowel movement. Fecal impaction often follows an extended period of constipation. Symptoms of Fecal Impaction? The most common symptoms of fecal impaction are: intense urge to have a bowel movement inability to have a bowel movement rectal pain abdominal cramping nausea

Cause of Fecal Impaction? There are many different causes of fecal impaction. Some of the most common causes are: inadequate consumption of fiber inadequate consumption of fluids pain relieving medications antidepressant medication antacids containing aluminum excessive laxative use bed rest hemorrhoids kidney disease cancer heart disease

Can Fecal Impaction be Treated? Yes. Fecal Impaction can be removed manually by a doctor. Medications can be used to prevent reoccurrences. In rare cases, surgery may be required to remove the impaction and/or part of the bowel. Other ways to prevent fecal impaction from reoccurring are: drink plenty of water eat a diet with plenty of fiber don't use laxatives on a regular basis avoid prolonged bed rest avoid medications that cause fecal impaction (antidepressants and excessive use of pain relievers) exercise on a regular basis

Fecal impaction
A fecal impaction is a large lump of dry, hard stool that remains stuck in the rectum. It is most often seen in patients with long-term constipation.

Causes
Constipation is when you are not passing stool as often as you normally do. Your stool becomes hard and dry, and it is difficult to pass. Fecal impaction is often seen in people who have had constipation for a long time and have been using laxatives. Impaction is even more likely when the laxatives are stopped suddenly. The muscles of the intestines forget how to move stool or feces on their own. Persons at risk for chronic constipation and fecal impaction include those who:

Do not move around much and spend most of their time in a chair or bed Have diseases of the brain or nervous system that damage the nerves that go to the muscles of the intestines

Certain drugs slow the passage of stool through the bowels:

Anticholinergics, which affect the interaction between nerves and muscles of the bowel Medicines used to treat diarrhea, if they are taken too often Narcotic pain medication, such as methadone and codeine

Symptoms
Common symptoms include:

Abdominal cramping and bloating Leakage of liquid or sudden episodes of watery diarrhea in someone who has chronic constipation Rectal bleeding Small, semi-formed stools Straining when trying to pass stools

Other possible symptoms include:

Bladder pressure or loss of bladder control Lower back pain Rapid heartbeat or light-headedness from straining to pass stool

Exams and Tests

The health care provider will examine your stomach area and rectum. The rectal exam will reveal a hard mass of stool in the rectum. If there has been a recent change in your bowel habits, your doctor may recommend a colonoscopy to evaluate for colon or rectal cancer.

Treatment
Treating a fecal impaction involves removing the impacted stool. After that, measures are taken to prevent future fecal impactions. Often a warm mineral oil enema is used to soften and lubricate the stool. However, enemas alone are usually not enough to remove a large, hardened impaction. The mass may have to be broken up by hand. This is called manual removal:

A health care provider will need to insert one or two fingers into the rectum and slowly break up the mass into smaller pieces so that it can come out. This process must be done in small steps to avoid causing injury to the rectum. Suppositories inserted into the rectum may be given between attempts to help clear the stool.

Surgery is rarely needed to treat a fecal impaction. An overly widened colon (megacolon) or complete blockage of the bowel may require emergency removal of the impaction. Almost anyone who has had a fecal impaction will need a bowel retraining program. Your doctor and a specially trained nurse or therapist will:

Take a detailed history of your diet, bowel patterns, laxative use, medications, and medical problems Examine you carefully Recommend changes in your diet, how to use laxatives and stool softeners, special exercises, lifestyle changes, and other special techniques to retrain your bowel Follow you closely to make sure the program works for you

Outlook (Prognosis)
With treatment, the outcome is good.

Possible Complications

Tear (ulceration) of the rectal tissue Tissue death (necrosis) or rectal tissue injury

When to Contact a Medical Professional

Tell your health care provider if you are experiencing chronic diarrhea or fecal incontinence after a long period of constipation. Also notify your health care provider if you are experiencing any of the following symptoms:

Abdominal pain and bloating Blood in the stool Sudden constipation with abdominal cramps, and an inability to pass gas or stool. In this case, do not take any laxatives. Call your health care provider immediately. Very thin, pencil-like stools

Alternative Names
Impaction of the bowels

Fecal Impaction vs. Constipation

Constipation and fecal impaction is not the same thing. Many people think that they are the same. While they both involve the intestines, bowels and fecal matter, they are two different problems that have to be treated differently. Constipation is the term used to describe slow moving feces or stool through the intestines. The longer it takes for fecal matter to be eliminated from the body, the drier and harder it will become. Symptoms of constipation include passing small, dry hard stools, a feeling of incomplete evacuation, straining, fatigue, bad breath, skin eruptions, abdominal pain, hemorrhoids and irregular bowel movements. Fecal impaction is the term used to describe a large mass of hard stool or fecal matter that is stuck" in the rectum. Symptoms of fecal impaction may be similar to constipation symptoms. However, in addition to those symptoms the individual may have bladder problems, back pain, nausea, vomiting, dehydration, a distended abdomen, a rapid heartbeat, sweating, fever, dizziness and even high or low blood pressure. Individuals who have a fecal impaction may also experience very explosive diarrhea. This diarrhea does not remove the impaction, it moves around the impaction. Constipation can be very uncomfortable and annoying. Fecal impaction is far more dangerous than constipation. Fecal impaction can be life threatening. Fecal impaction that is not treated can worsen and the individual could possibly die from it. Constipation can be caused by numerous things including not eating enough fiber, not drinking enough liquids, a lack of exercise, certain medications, changes in lifestyle or routine, ignoring the urge to move your bowels, abusing laxatives, irritable bowel syndrome, pregnancy, traveling and other various reasons.

Fecal impaction can be caused by ignoring constipation, pain medications, illness and long term use of laxatives. Many people are surprised to learn that prolonged use of stimulant laxatives can lead to fecal impaction, but it is true. With prolonged use the colon can become dependent upon the laxative to aid it in evacuation. When the colon has been exposed to laxatives and stool softeners for a period of time and then it does not get the expected dose, constipation and fecal impaction can occur. To put it simply, prolonged laxative use can make your body forget how to move and evacuate fecal matter on its own. If constipation is not addressed and an individual develops fecal impaction it cannot be treated as easily. Fecal impactions in the rectum must be removed manually by a medical professional. Constipation should be addressed at its onset to prevent a fecal impaction. Steps to alleviate constipation can include making changes in the diet, drinking an adequate amount of water, exercising and doing a colon cleanse. Tips to aid in stool evacuation include the following:

When you are sitting on the toilet, it is important that you do not hold your breath when you are trying to eliminate a stool. A good constipation tip is to breathe in your nose and out through your mouth. Holding your breath while you are trying to pass a stool can actually hamper the elimination process because it closes up the bottom. Learn how to push without straining. When you have placed your feet on the stool, simply lean forward and breathe normally. This will enable your stomach muscles to push the stool out without straining. Essentially, you are pushing from your waist. You should always respond to any sign that your bowels want to move. Delaying or putting off a bowel movement can aggravate constipation. No matter where you are, if you feel like your bowels want to move, find a bathroom.