Fecal Impaction: Risk Factors and Treatment

Causes of Fecal Impaction

Fecal impaction is when stool forms that is hard, dry, and difficult to pass on its own. It is more severe than constipation. Individuals who experience constipation are more at risk of fecal impaction.

Lifestyle Risk Factors

• Lack of fiber
• Immobility
• Dehydration
• Not drinking enough

Medical Conditions

• Structural disorders of the colon and anus (e.g., megacolon)
• Prior surgical interventions of the anus and colon
• Neurological disorders (e.g., Parkinson’s disease, multiple sclerosis, Alzheimer’s disease)
• Metabolic disorders (e.g., hypothyroidism or hypercalcemia)
• Medication side effects (e.g., opioids, tricyclic antidepressants, and anticholinergics)
• Spinal cord injury

Symptoms

Fecal impaction usually causes abdominal discomfort similar to constipation but more intense and for a more extended period. Unlike constipation, which is difficulty passing stools, with fecal impaction, the stool has become too hard to pass without intervention. Fecal impaction can be a complication of constipation.

• Abdominal cramping
• Abdominal discomfort
• Abdominal pain
• Abdominal distension
• Fecal soiling
• Loss of appetite
• Back pain
• Nausea
• Vomiting
• Rectal bleeding
• Straining to poop
• Lower back pain
• Loss of bladder control or leaking
• Agitation

Complications

Fecal impaction can cause several complications, including:

• Ulcers in the colon from increased stool pressure
• Colitis
• Bowel perforation
• Pulmonary aspiration
• Rectovaginal fistula (an abnormal connection between the rectum and vagina that allows stool to enter the vagina)
• Urinary retention
• Megacolon
• Colon perforation
• Peritonitis

Diagnosis

There are many causes of abdominal pain and cramping. Fecal impaction may not be the apparent cause of your symptoms at first. Initially, the symptoms may appear similar to a bowel obstruction.

• Medical history
• Imaging (e.g., abdominal series or CT scan)

Treatment

Fecal impaction is treated by medications to soften the stool and encourage it to pass, as well as enemas, digital disimpaction, other procedures, and surgery in more severe cases.

• Laxatives
• Enemas
• Water irrigation
• Oral or nasogastric tube
• Manual procedure
• Emergency fecal impaction surgery

Prevention

Prevention is essential, as up to 39% of individuals who experience a fecal impaction will have a recurrence of the condition.

• Daily movement
• Increasing fluid consumption
• Increasing daily fiber intake
• Ensuring individuals have easy access to the restroom whenever needed

Summary

Fecal impaction is a common, uncomfortable condition most frequent in the elderly. It can often be prevented by ensuring adequate fiber intake, daily exercise, and drinking plenty of water. However, in some cases, underlying medication conditions predispose an individual to fecal impaction (e.g., individuals who are bed-bound or need medications that make constipation more likely).