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Fecal Impaction – Symptoms, Removal of Impacted Stool in Rectum

What is fecal impaction?

Fecal impaction, or impacted stool/ feces, is the accumulation of stool into a large, hard and dry mass within the lower part of the large bowels i.e. rectum and sometimes extending into the sigmoid colon.

Removal of the impaction is necessary in order to restore normal bowel movement as the mass cannot be passed spontaneously upon defecation due to its size. It is often a result of constipation, therefore, the cause of the constipation needs to be identified and treated in order to prevent future occurrences of impacted feces.

Causes of Fecal Impaction

The cause of fecal impaction is usually the same as severe constipation. The causative factors have been discussed extensively under What Causes Constipation?

Furthermore, severe constipation is a symptom of a number of bowel disorders including partial and complete bowel obstruction. Constipation to the extent that it can result in fecal impaction may also be a consequence of using certain medication like strong painkillers, anticholinergic or antidiarrheal drugs or other substances like certain narcotics.

Fecal impaction is not a common occurrence in constipation, except in certain predisposing circumstances. Most notably, it tends to occur in the elderly, particularly bedridden and inactive (sedentary) patients.

Complications of Fecal Impaction

Prolonged or untreated fecal impaction may cause a megacolon. This is an abnormal dilatation (widening, enlargement) of the colon. With time, impaction will damage the mucus lining, affect colonic motility and impair blood flow to the bowel. The latter can progress into ischemic bowel disease.

Symptoms of Impacted Feces

  • Watery stool or diarrhea (paradoxical diarrhea) as liquid bowel contents bypass the impacted mass. Thin, pencil-like stool may also be noted.
  • Fresh blood in the stool or rectal bleeding noted upon wiping
  • Excessive straining when passing even small amounts of stool
  • Pain upon defecating
  • Fecal incontinence
  • Abdominal pain and intestinal cramping
  • Bloating or swollen abdomen

Generalized symptoms may include :

  • General feeling of being unwell
  • Lack of appetite
  • Nausea and/or vomiting
  • Restlessness

Treatment of Fecal Impaction

Removal of the impacted mass is often necessary in order to restore normal bowel function. This does not usually require surgical intervention. Manual breaking and removal of the mass is done digitally per rectal (entry through the anus into the rectum) when other therapeutic means listed below fails to yield results.

  • Medication like stool softeners, laxatives and bulking agents. Laxatives may increase abdominal pain, cramping and vomiting in a case of fecal impaction.
  • Dietary changes – eat foods that are known to relieve constipation (refer to Constipation Diet) and avoid foods that may contribute to constipation (refer to Foods that Cause Constipation).
  • Increasing water intake and exercise may also be effective.
  • Daily enemas may be helpful in dislodging the impaction or at least limiting its growth any further.

Removal of Impacted Stool

Manual removal of impacted feces should NOT be done in the home environment or without medical supervision. It should be done by a nurse or doctor. Improper removal may cause damage or even tears to the bowel and trigger a vasovagal response.

  • The nurse will insert the gloved and lubricated index finger through the anus to reach the mass.
  • Careful massaging around the mass may be necessary to dislodge it from the wall of the rectum.
  • Firm pressure on the mass should allow pieces to break off.
  • The pieces are gently guided down the rectum through the anus.

An enema or suppository is necessary afterwards. Subsequent bowel movements may expel any remaining pieces.