Fecal impaction is a form of chronic constipation where a large, hardened mass of stool becomes lodged in the rectum or sigmoid colon and cannot be passed normally. The condition often causes discomfort, and fecal impaction can cause back pain, most commonly felt in the lower back or lumbar region. This connection is a direct consequence of the physical pressure the impacted mass exerts on the surrounding anatomical structures.
The Mechanism Linking Impaction and Pain
The pain associated with fecal impaction stems from the physical presence of the hardened stool mass within the lower digestive tract. As the mass accumulates in the rectum and the lower part of the colon, it expands and exerts pressure on neighboring structures in the pelvic cavity. This pressure is specifically directed toward the sacrum, the triangular bone at the base of the spine, and the coccyx, or tailbone.
The physical compression of the stool mass directly irritates the sacral nerves, which supply sensation and motor function to the lower back, buttocks, and legs. This irritation is experienced as a dull, aching, or constant pressure perceived as lower back pain. The resulting discomfort is a type of referred pain due to shared nerve pathways. Resolving the impaction typically results in the rapid relief of this specific back pain, confirming the mechanical cause.
Other Key Symptoms of Fecal Impaction
Fecal impaction is typically accompanied by a cluster of gastrointestinal symptoms. A common and often confusing sign is the leakage of liquid stool, referred to as paradoxical diarrhea. This occurs because watery stool from higher up the colon manages to bypass the solid, obstructing mass, leaking out of the rectum.
The retained stool causes abdominal cramping, bloating, and distension or swelling of the abdomen. The inability to pass gas or have a normal bowel movement is a persistent sign that obstruction has formed. Nausea and vomiting may also occur as the blockage prevents the normal flow of waste.
The pressure on the pelvis can affect the urinary system, sometimes leading to bladder pressure or a loss of bladder control. General signs of distress, such as lethargy, loss of appetite, or malaise, are also frequently reported.
Treatment and Prevention
The treatment for fecal impaction focuses on removing the hardened stool mass, a process known as disimpaction. Medical professionals usually begin with less invasive methods, such as administering oral laxatives or polyethylene glycol solutions to soften the stool. Rectal treatments, including suppositories or warm tap water enemas, may be used to deliver fluid directly to the impacted area to lubricate and break up the mass.
If these initial steps are unsuccessful, a healthcare provider may need to perform manual disimpaction, where a gloved finger is used to manually break up the stool in the rectum. In severe cases, such as when there is a risk of bowel perforation, hospitalization or a surgical procedure may be necessary. Consult a medical professional before attempting any treatment to ensure safety.
Long-term strategies are necessary to prevent recurrence and maintain regular bowel function, which includes adjustments to diet and lifestyle. Increasing the intake of dietary fiber, found in foods like whole grains, fruits, and vegetables, adds bulk to the stool and hastens its passage through the colon.
Adequate hydration is important, as sufficient water intake prevents the colon from absorbing too much liquid from the waste, which is a primary cause of hard, dry stool. Regular physical activity promotes normal muscle contractions in the bowel, aiding in stool movement and reducing the risk of a future impaction.