Fecal impaction

Other possible symptoms include:

Faecal impaction

Long term or chronic constipation can lead to faecal impaction. Chronic constipation means difficulty having a poo that can last for several weeks or longer.

What is faecal impaction?

Faecal impaction means having a large amount of dry, hard poo (stool or faeces) in the back passage (rectum). The diagram shows the parts of the bowel, including the rectum.

Overflow diarrhoea

One main symptom of faecal impaction is overflow diarrhoea. The constipated poo in your bowel is so hard that you can’t push it out. So your bowel begins to leak out watery stools around the poo. The watery stools pass around the blockage and out of your rectum. The leakage can soil your underwear and appear like diarrhoea.

If you’ve had severe constipation and then develop diarrhoea you should not take anti diarrhoea medicines. You must talk to your doctor or nurse before taking anything.

Causes of faecal impaction

The main causes of faecal impaction are similar to those of constipation. They include:

• side effects from painkilling medicines
• lack of exercise over a long period of time
• a low fibre diet
• long term use of laxatives
• depression and anxiety

Symptoms of faecal impaction

The symptoms of impaction are similar to the symptoms of constipation. But other more serious symptoms can occur. These include:

• back pain due to the mass of poo pressing on the nerves in your lower back (the sacral nerves)
• a swollen tummy (abdomen)
• high or low blood pressure
• a fast heart rate
• dizziness
• sweating
• a high temperature (fever)
• severe diarrhoea that you have no control over
• feeling and being sick
• severe tummy pain
• dehydration – you may feel dizzy, light-headed, or tired, or have a dry mouth, lips, and eyes, and pass small amounts wee infrequently (less than three or four times a day)
• swelling around the back passage (rectum)
• a numb feeling around the anus
• bleeding around the anus

Treating faecal impaction

Doctors and nurses usually treat impaction by moistening and softening the poo with an enema or suppositories. It is very important that you use enemas carefully and only as prescribed by your doctor. Too many enemas can damage the bowel.

If the enema doesn’t move the poo, a trained nurse or doctor might need to physically remove the hard poo from your back passage. You should not do this yourself. Understandably, you may find this procedure uncomfortable and embarrassing. But it is very important to clear the bowel.

Let your doctor or nurse know if you have any changes in your bowel habits. If you think you have an impaction, don’t take any laxatives without first discussing it with your doctor or specialist nurse. Laxatives that stimulate the bowel can cause severe cramping and might damage your bowel.

References

• Constipation – Clinical Knowledge Summaries
  National Institute for Health and Care Excellence (NICE), revised March 2022
• Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines P.J Larkin and others Annals of Oncology, 2018. Vol 29, Supplement 4.
• Management of Constipation in Adults
  Hull and East Riding Prescribing Committee guidelines, May 2016
• Managing Constipation in Adults With Cancer R J Wickham, Journal of Advanced Practioner in Oncology, 2017. Volume 8, Issue 2, Pages 149–161.
• Chronic Idiopathic Constipation in Adults: A Review on Current Guidelines and Emerging Treatment Options
  G Bassotti, P Usai Satta, and M Bellini
  Clinical and Experimental Gastroenterology, 2021, Volume 14, Pages 413–428.

Fecal impaction

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.

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:

• You do not move around much and spend most of your time in a chair or bed.
• You have a disease of the brain or nervous system that damages the nerves that go to the muscles of the intestines.

Certain medicines slow the passage of stool through the bowels:

• Anticholinergics, which affect the interaction between nerves and muscles of the bowel
• Medicines used to treat diarrhea, if they are taken too often
• Narcotic pain medicine, such as methadone, codeine, and oxycodone

Symptoms

Common symptoms include:

• Abdominal cramping and bloating
• Leakage of liquid or sudden episodes of watery diarrhea in someone who has chronic (long-term) constipation
• Rectal bleeding
• Small, semi-formed stools
• Straining when trying to pass stools

Other possible symptoms include:

• Bladder pressure or loss of bladder control
• Lower back pain
• Rapid heartbeat or lightheadedness from straining to pass stool

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:

• A provider will need to insert one or two fingers into the rectum and slowly break up the mass into smaller pieces so that it can come out.
• This process must be done in small steps to avoid causing injury to the rectum.
• Suppositories inserted into the rectum may be given between attempts to help clear the stool.

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:

• Take a detailed history of your diet, bowel patterns, laxative use, medicines, and medical problems
• Examine you carefully.
• Recommend changes in your diet, how to use laxatives and stool softeners, special exercises, lifestyle changes, and other special techniques to retrain your bowel.
• Follow you closely to make sure the program works for you.

Outlook (Prognosis)

With treatment, the outcome is good.

Possible Complications

Complications may include:

• Tear (ulceration) of the rectal tissue
• Tissue death (necrosis) or rectal tissue injury

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:

• Abdominal pain and bloating
• Blood in the stool
• Sudden constipation with abdominal cramps, and an inability to pass gas or stool. In this case, do not take any laxatives. Call your provider right away.
• Very thin, pencil-like stools

Alternative Names

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

Patient Instructions

Images

• Digestive system
• Digestive system organs

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

Updated 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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