Fecal impaction is a severe form of constipation where hardened stool becomes firmly lodged in the rectum or lower colon, making it impossible to pass. This occurs due to prolonged stool retention in the large bowel, leading to excessive water absorption and hardening. Factors contributing to fecal impaction include chronic constipation, certain medications like opioids, insufficient dietary fiber, and inadequate fluid intake.
Recognizing Fecal Impaction
Fecal impaction symptoms differ from typical constipation. Common indicators include abdominal pain, bloating, nausea, and a feeling of fullness in the rectum. Individuals might also experience loss of appetite, vomiting, or leakage of liquid stool around the hardened mass (encopresis).
Other symptoms include lower back pain, bladder pressure, or loss of bladder control. Straining when attempting to pass stools, small semi-formed stools, rapid heartbeat, or lightheadedness from straining are also possible.
Seek immediate medical attention if severe symptoms develop, such as intense abdominal pain, fever, or inability to pass gas or stool. Confusion, dehydration, or worsening of symptoms also warrant prompt consultation with a healthcare provider. Attempting self-diagnosis and self-treatment without professional guidance can lead to serious complications, including rectal injury or bowel perforation.
Medical Approaches to Fecal Disimpaction
A healthcare professional will confirm the diagnosis of fecal impaction, often through a digital rectal examination to feel the hardened stool mass. Imaging techniques may also assess the impaction’s location and extent.
Medical interventions often begin with non-manual methods. Oral laxatives, like polyethylene glycol, soften stool and promote bowel movements, especially for impactions higher in the colon. Suppositories and enemas (e.g., mineral oil, saline solutions) also soften impacted stool and stimulate evacuation, particularly for distal impactions.
For severe cases, manual disimpaction may be necessary. A healthcare professional uses gloved fingers to carefully break up and remove hardened stool from the rectum. This process is done gently to avoid injury to the rectum.
Manual disimpaction must only be performed by a trained medical professional. Self-attempting this procedure carries significant risks, including rectal injury, anal fissures, infection, or a vagal response which can lead to a sudden drop in heart rate and fainting. In severe instances, it may be performed in an operating room under anesthesia.
Home Management and Prevention
After medical disimpaction, a prescribed bowel regimen is important to prevent recurrence. This involves dietary adjustments and lifestyle changes.
Increasing dietary fiber is a primary preventive measure. Fiber-rich foods like fruits, vegetables, and whole grains add bulk to stool, making it softer and easier to pass. Adequate fluid intake, especially water, also keeps stools soft and prevents hardening.
Regular physical activity stimulates intestinal muscle contractions, which aids in moving stool through the digestive tract. Establishing a consistent toilet routine and responding promptly to bowel urges prevents stool accumulation and hardening. Individuals should also discuss chronic medications with their doctor, as some can contribute to constipation and may need adjustment.