Constipation

Overview, Causes, & Risk Factors
Fecal impaction is a severe form of constipation in which a large mass of stool cannot be passed.

What is going on in the body?
This condition most commonly occurs in the older people, although it can occur at any age. Usually, the person has severe constipation for several days before they develop symptoms. Some of the stool may become quite hard and block the intestines, so that other stool cannot be pushed out. Most often, the blockage occurs close to the anus.

What are the causes and risks of the condition?
Fecal impaction occurs in elderly or bedridden persons who are constipated over a long period of time. Rectal disorders such as painful hemorrhoids can also cause fecal impaction. Individuals who use laxatives too often may develop impaction when they stop taking laxatives. A person whose diet doesn’t include enough fiber and fluid is at risk for fecal impaction.

Symptoms & Signs
What are the signs and symptoms of the condition?
Each of the following symptoms generally gets worse the longer the condition goes untreated:

constipation
swelling of the abdomen
nausea and vomiting
thin watery discharge from the rectum
abdominal distress or cramping
fever
Diagnosis & Tests
How is the condition diagnosed?
Often, the healthcare provider can push on the abdomen and feel the enlarged intestines that are full of stool. An abdominal x-ray may be taken to confirm the diagnosis. Obstruction of the bowel can occur for different reasons, so the bowel is usually emptied with an enema or laxative first. Then, a barium enema is done to look at the inside of the bowel. These tests can show whether there is cancer or an infection causing an obstruction.

Prevention & Expectations
What can be done to prevent the condition?
Fecal impaction can be prevented by eating a normal, well-balanced diet following the Food Guide Pyramid. This includes foods that are high in fiber as well as fa luid intake of at least 6 to 8 glasses per day. Persons with chronic constipation are often given stool softeners, such as docusate, or enemas to prevent this problem.

What are the long-term effects of the condition?
Fecal impaction usually has no long-term effects. However, it may happen again and again unless the underlying cause is corrected. If an impaction happens often, the colon may be damaged or an infection may occur.

What are the risks to others?
There are no risks to others.

Treatment & Monitoring
What are the treatments for the condition?
The bowel needs to be emptied. Often, the impaction may be fixed by inserting a lubricated finger into the anus and breaking up the hardened stool. Other times, an enema or laxative is required to get the stool to move. Sometimes antibiotics are needed if an infection develops. Very rarely, part of the bowel may need to be removed with surgery.

What are the side effects of the treatments?
Enemas and laxatives can cause dehydration and salt imbalances in the body. However, they are usually well tolerated.

What happens after treatment for the condition?
A person with a fecal impaction usually recovers quickly.

How is the condition monitored?
After fecal impaction, a person needs to be monitored closely to make sure the impaction doesn’t occur again. A diet high in fiber, increased fluid intake, stool softeners, and enemas may all be advised.