What is fecal impaction?
Fecal impaction is a condition where a large, hard mass of stool gets stuck in the rectum or lower colon, making it difficult or impossible to pass naturally. It’s a more severe form of constipation and can cause serious complications if not treated promptly.
It often occurs in people who have been constipated for a long time or those who are unable to feel the need to go to the bathroom.
What causes fecal impaction?
Fecal impaction usually develops gradually after prolonged constipation, but several factors can increase the risk.
Common causes and risk factors:
- Chronic constipation
- Low fiber diet
- Dehydration
- Limited physical activity or immobility
- Ignoring the urge to have a bowel movement
- Nerve damage affecting the colon or rectum (e.g., after stroke, spinal injury)
- Certain medications – such as opioids, anticholinergics, and calcium-channel blockers
- Neurological or cognitive disorders – like Parkinson’s disease or dementia
What are the symptoms of fecal impaction?
The symptoms may be similar to constipation at first but can become more serious as the blockage worsens.
Common signs and symptoms:
- Inability to pass stool or gas
- Abdominal bloating and discomfort
- Nausea or vomiting
- Straining or pain during bowel movements
- Leaking of liquid stool (diarrhea-like) – may be a sign of stool leaking around the impaction
- Feeling of fullness or pressure in the rectum
- Loss of appetite
- Confusion – especially in older adults
How is fecal impaction diagnosed?
Doctors can usually diagnose fecal impaction through a combination of a medical history review, physical exam, and sometimes imaging tests.
Diagnostic methods include:
- Digital rectal exam – the doctor feels for a hard mass in the rectum
- Abdominal X-ray – to detect blocked or backed-up stool in the colon
- CT scan – in more complex or unclear cases
How is fecal impaction treated?
The goal of treatment is to remove the impacted stool and prevent it from happening again.
Treatment options:
- Manual removal – a healthcare provider may need to break up and remove stool with a gloved finger
- Enemas – used to soften and flush out the stool (e.g., saline or oil-retention enemas)
- Suppositories – such as glycerin or bisacodyl to stimulate bowel movement
- Oral laxatives – after initial removal, to clear remaining stool
- Hydration and dietary changes – to prevent recurrence
In severe or unresponsive cases, hospitalization may be needed.
Can fecal impaction lead to complications?
Yes. If untreated, fecal impaction can cause serious health issues.
Possible complications include:
- Tears in the rectum (anal fissures)
- Hemorrhoids
- Bowel perforation – a rare but life-threatening condition
- Urinary retention or infections
- Chronic constipation or incontinence
How can fecal impaction be prevented?
Preventing impaction starts with good bowel health and regular habits.
Tips for prevention:
- Eat a high-fiber diet – include fruits, vegetables, and whole grains
- Drink plenty of water
- Exercise regularly
- Respond promptly to the urge to go
- Avoid overuse of laxatives
- Manage underlying conditions that affect bowel movements
- Talk to your doctor if you’re on medications that cause constipation