What Is Fecal Impaction?

Fecal impaction is a state of prolonged constipation. It happens when the stool (poop) is so hard that it cannot pass with a normal bowel movement. It causes abdominal discomfort. Rarely, it can cause serious medical complications.

Risk factors that can cause fecal impaction include a high-fat diet, prolonged immobility, and psychological factors. But the condition can also occur without a specific reason.

Fecal impaction can be treated with medicine or with a procedure to remove the hard stool.

Fecal Impaction Symptoms

Fecal impaction usually causes abdominal discomfort similar to constipation, but more intense and for a longer period of time.

You will likely have other symptoms in addition to constipation. The symptoms typically get worse the longer you go without a bowel movement.

Symptoms of fecal impaction include:

• Abdominal cramping
• Abdominal discomfort
• Abdominal pain
• Abdominal distension
• Fecal soiling
• Loss of appetite
• Back pain
• Nausea
• Vomiting
• Bad breath
• Hemorrhoids (enlarged rectal blood vessels)

Complications

In rare cases, untreated fecal impaction can result in serious health complications, such as:

• Bowel ulceration
• Perforation
• Thrombosed hemorrhoids (a blood clot in a rectal blood vessel)
• Gastrointestinal infection
• Peritonitis (an infection that spreads outside the gastrointestinal system)

If these complications occur, symptoms can include fevers, chills, rectal bleeding, low blood pressure, rapid heart rate, dizziness, or loss of consciousness.

Fecal Impaction Causes

Fecal impaction typically happens when a person hasn't had a bowel movement for many days. Several common lifestyle risk factors can increase the chances. Some illnesses can make you prone to the condition, and certain populations are at higher risk.

Common lifestyle risk factors include:

• Lack of fiber in the diet
• High-fat diet
• Not eating or drinking enough, dehydration
• Lack of access to a toilet, due to traveling or other circumstances
• Excessive stress
• Reluctance to have a bowel movement

Medical conditions that increase the risk are:

• Neurological impairment
• Extended periods of physical immobility
• Inability to eat or drink
• Post-surgical bowel dysfunction
• Bowel obstruction (blockage)
• Thyroid disease
• Medication side effects

Some populations are at a higher risk of fecal impaction, such as:

• Older adults residing in nursing homes who have minimal or no physical activity
• Individuals with neurological conditions that can impair bowel motility, such as Alzheimer's disease, Parkinson's disease, dementia, spinal cord injury, or stroke
• Children, particularly those who avoid having a bowel movement out of anxiety, embarrassment, or to avoid pain
• People taking medications that produce the side effect of constipation, such as some antihypertensive medications, antidepressants, and muscle relaxers
• Individuals who take narcotics, the category of medication most closely associated with constipation, which may cause a condition known as narcotic bowel syndrome
• People who overuse or abuse laxatives (stool softeners), which can have a paradoxical effect on the colon, making it unable to function normally
• Individuals who have structural and functional conditions involving the small intestine, colon, or rectum, due to gastrointestinal disease, cancer, or surgery

Diagnosis

There are many causes of abdominal pain and cramping. Fecal impaction may not be the obvious cause of your symptoms at first.

Your healthcare provider will diagnose you based on your medical history, physical examination, and diagnostic tests if needed.

• Medical history: If you complain of recent constipation and decreased bowel movements, or if you have had fecal impaction in the past, this raises suspicion that you could have fecal impaction.
• Physical examination: Your physical examination may reveal that you have a hard abdomen, that you have pain or tenderness when your healthcare provider presses on your abdomen, or that your abdomen appears distended (swollen or larger than usual).
• Imaging: Diagnostic imaging tests may be done to confirm the diagnosis. An abdominal plain film X-ray would show if the colon is full of stool. Sigmoidoscopy is an invasive test involving the insertion of a small camera into the rectum to view the inner colon.

Fecal Impaction Treatment

Fecal impaction can be treated with medication. It may require a procedural intervention for particularly resistant situations. It's important that you see a healthcare provider so you can be evaluated, as this will dictate the best treatment for you.

The method of treatment depends on whether your healthcare providers have diagnosed a recent fecal impaction or a fecal impaction that has lasted for days or longer.

The treatment also depends on whether there is one area or multiple areas of impaction, where they are located within your colon, and whether the stool is very hardened or difficult to soften with medication.

Laxatives

Providers typically recommend laxatives first. Usually in oral form, these medications soften the hardened stool so that it can be passed. If you do not regularly use laxative medications, they should be effective relatively quickly.

You can expect to have at least one, if not more, large bowel movements within a few hours after using a laxative, and possibly for the next several days. It is best to remain where you can easily get to a toilet. However, this may not be a suitable treatment for some older people.

Sometimes a laxative is used as a suppository, meaning that it is taken in a form that is inserted into the rectum, rather than taken by mouth. This should work more quickly than an oral laxative and is a preferred method if the impaction is particularly distal (low down) in the colon.

Procedures

There are also fecal impaction treatments that more actively remove the stool:

• Enema: An enema is a treatment in which a liquid is injected into the rectum. Your healthcare provider or nurse may inject the liquid using a nozzle or may give you instructions to use an enema at home. The liquid material contains ingredients that soften the stool so you can have a bowel movement.
• Water irrigation: With this method, your healthcare provider gently inserts a tube that injects water into the rectum to loosen the stool, allowing you to have a bowel movement.
• Manual procedure: In severe cases, the blockage may need to be manually removed with a procedure. Your healthcare provider would gently locate the area or areas of fecal impaction by feeling the outside of your abdomen and would carefully place a gloved finger into the rectum to relieve the obstruction.

Emergency fecal impaction surgery may be needed if there is a complete bowel blockage or if the colon is abnormally dilated (megacolon), but such cases are rare.

Prevention

If you or a loved one is at risk of developing fecal impaction, preventative strategies are essential. Increasing your dietary fiber intake and water consumption can be very helpful.

Depending on your medical condition, your healthcare provider may recommend that you regularly use stool softeners or laxatives to prevent constipation. This decision has to be weighed carefully because laxatives can make your colon less responsive and functional than normal.

Your healthcare provider also may make changes to any of your medications that are contributing to constipation. If you have had neurological damage or intestinal surgery, bowel retraining exercises may also be recommended.

A Word From Verywell

Let your healthcare provider know if you experience pain caused by constipation, or if you haven't had a bowel movement for several days. These problems can be treated more easily in the early stages, and treatment can prevent serious complications.