Fecal impaction

Definition

A fecal impaction is a large lump of dry, hard stool that stays stuck in the rectum. It is most often seen in people who are constipated for a long time.

Alternative Names

Impaction of the bowels; Constipation - impaction; Neurogenic bowel - impaction

Causes

Constipation is when you are not passing stool as often or as easily as is normal for you. Your stool becomes hard and dry. This makes it difficult to pass.

Fecal impaction often occurs in people who have had constipation for a long time.

You are at more risk for chronic constipation and fecal impaction if:

Certain medicines slow the passage of stool through the bowels:

Symptoms

Common symptoms include:

Other possible symptoms include:

Exams and Tests

The health care provider will examine your stomach area and rectum. The rectal exam will show a hard mass of stool in the rectum.

You may need to have a colonoscopy if there has been a recent change in your bowel habits. This is done to check for colon or rectal cancer.

Treatment

Treatment for the condition starts with removal of the impacted stool. This is called disimpaction. After that, steps are taken to prevent future fecal impactions.

A warm tap water enema is often used to soften and lubricate the stool. You may need more than one enema to help.

The mass may have to be broken up by hand. This is called manual removal:

Surgery is rarely needed to treat a fecal impaction. An overly widened colon (megacolon) or complete blockage of the bowel may require emergency removal of the impaction.

Most people who have had a fecal impaction will need a bowel retraining program. Your provider and a specially trained nurse or therapist will:

Outlook (Prognosis)

With treatment, the outcome is good.

Possible Complications

Complications may include:

When to Contact a Medical Professional

Tell your provider if you have chronic diarrhea or fecal incontinence after a long period of constipation. Also tell your provider if you have any of the following symptoms:

References

Iturrino JC, Lembo AJ. Constipation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 19.

Zainea GC. Management of fecal impaction. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 208.


Review Date: 12/31/2023
Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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