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Fecal Impaction: Everything You Need to Know About Impacted Bowel

Pooping is a natural and necessary bodily function that most people don’t give much thought to when it’s happening regularly. But if this system in your body isn’t working correctly and you find yourself experiencing constipation regularly, it’s important to understand bowel impaction, including its symptoms, causes, and potential treatments.

Normally, stool moves through the body via a process called peristalsis. When the process of peristalsis stops, changes, or slows down, hardened fecal material sits in the large bowel or rectum. This hardened fecal matter, if not recognized and treated, can result in the formation of fecaliths, which are stone-like feces. Fecal impaction may also be referred to as coprostasis or inspissated stool syndrome.

Fecal impaction is one of the most common causes of lower gastrointestinal (GI) tract obstruction. It typically follows untreated chronic or severe constipation. This condition is particularly common in the elderly population, especially patients with neuropsychiatric disorders like Alzheimer's disease, Parkinson’s disease, dementia, or stroke. An impacted bowel can significantly impair one’s quality of life.

The symptoms of fecal impaction are similar to those found with many GI obstruction issues. They include constipation, nausea, vomiting, headache, abdominal pain, anorexia, and urinary frequency or urinary overflow incontinence (leaking urine). Paradoxical diarrhea (when liquid stool leaks around the bowel impaction) can also occur, appearing as stool incontinence and potentially masking the problem of a severely impacted bowel or colon. 

The symptoms of fecal impaction include constipation, nausea, vomiting, headache, abdominal pain, anorexia, and urinary frequency.

In the presence of bowel impaction, the elderly population suffering from neuropsychiatric disorders may also have symptoms of confusion, agitation, worsening psychosis, or autonomic dysreflexia (an imbalance in your digestive system causing urinary or incontinence issues).

Additional complications can result from untreated bowel impaction. As pressure increases in the colon, there’s a decrease in perfusion (blood supply) of the colon’s mucosa and walls. This lack of perfusion and increased pressure can cause ulceration, which can lead to bowel perforation, megacolon, rectal bleeding, and/or rectovaginal fistula.

The causes of fecal impaction are similar to the causes of usual constipation. It’s important to understand that fecal impaction is a result of chronic and/or untreated constipation. There are many causes of constipation, and some of the causes provide transient effects, while others have more long-term impact.

  • Metabolic disorders: Hypothyroidism, diabetes mellitus, porphyria, hypercalcemia, and uremia can cause constipation.
  • Dietary disorders: This includes poor fluid/fiber intake, anorexia, bulimia, and chronic dehydration.
  • Medications: Opioids are an extremely common cause of constipation. Antipsychotics, iron, and calcium channel blockers can also lead to constipation.
  • Neurogenic conditions: Spinal cord injury, multiple sclerosis, and Parkinson’s disease can all affect gastrointestinal function.
  • Psychiatric conditions: This includes conditions like Alzheimer's disease and dementia.
  • Anatomic abnormalities: Anorectal malformations, megarectum/megacolon (caused by Chagas disease, Hirschsprung’s disease), anorectal stenosis (narrowing of the anal canal), and neoplasm (abnormal tissue mass) are common causes of an impacted bowel.
  • GI functional abnormalities: Abnormal rectal sensation (caused by Crohn’s disease), pelvic floor dysfunction (caused by rectocele or enterocele (blocking herniations or bulges), pregnancy, non-relaxing puborectalis syndrome, and increased rectal compliance/stretch (caused by irritation or endometriosis) are all mechanical complications that can affect the peristalsis process.
  • Poor mobility: Overall mobility is extremely important to GI motility. Bedrest, age, or physical complications can lead to poor body mobility routines.
  • Laxative abuse: Though counterintuitive, excessive laxative use can diminish the body’s normal response to a distended colon, requiring excessive dosages to result in stool movement.

Though constipation is common and may often be treated at home, fecal impaction is a serious, and potentially fatal condition that needs to be seen and treated by a medical professional. There are a variety of ways your care provider may treat impacted stool or assist in fecal impaction removal.

Manual disimpaction: If your provider determines that there is hardened stool in your rectum, they may be able to use lubrication and a gloved finger to gently break the impacted stool apart. If needed, they may use an anoscope, anal retraction, and suction.

Manual disimpaction, distal softening, and washout are some of the ways to relieve fecal impaction.

Distal softening or washout: If you have used or heard of enemas or suppositories, then you have some understanding of distal softening. During this procedure, a combination of water and an osmotic agent (like a stool softener) are administered rectally to soften the stool and add volume to the rectum. The extra volume should stimulate the rectum to pass any stool lodged inside. Sometimes the process needs to be repeated.

Proximal softening or washout: With proximal fecal impactions, the ideal laxatives used are magnesium citrate or polyethylene glycol. Large volumes (1–3 liters) are administered over a few hours until a bowel movement occurs. These laxatives may be taken orally if a provider has ruled out any bowel obstructions. 

You may be wondering if there are any impacted stool home remedies or how to soften impacted stool on your own. While a care provider needs to be involved in the presence of severe symptoms or complications, there are some things you can do to avoid fecal impaction and its complications.

The best way to treat fecal impaction is to avoid it altogether by taking preventive measures. Constipation is a common condition, but it can often be managed by paying attention to diet and exercise/movement. Staying hydrated and consuming 30 grams of fiber per day is a good starting place.

The best way to treat fecal impaction is to avoid it altogether by taking preventive measures.

Moving your body matters as well. Maybe you can stand while you work, take ten-minute breaks to take a walk, or get consistent exercise at least three times a week Find a way to sneak more movement into your life; small changes can go a long way.

Pay attention to your mental health as well. Depression can be the root cause of many constipation aggravators. If you suffer from (or believe you may suffer from) depression, it’s important to address it with professional help before the condition begins to physically affect your body.

There are a variety of things that can cause constipation. However, chronic and untreated constipation can lead to fecal impaction, which can severely affect your health and quality of life. If you don’t have another underlying condition, you may be able to prevent constipation by moving your body, eating well, and drinking water. If you notice signs of chronic constipation or other signals from your GI system, don’t ignore what your body is trying to tell you. Timely treatment can prevent complications so you’re feeling back to your normal self sooner than later.

https://www.ncbi.nlm.nih.gov/books/NBK448094/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348734/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709889/

https://journals.lww.com/jcge/fulltext/2000/04000/fecal_impaction__not_always_a_benign_condition.4.aspx

https://www.ncbi.nlm.nih.gov/pubmed/2313155

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