Fecal Impaction

What is fecal impaction?

Fecal impaction is the result of severe constipation, when you're unable to regularly pass poop (stool or feces) and it backs up inside your large intestine (colon). Fecal impaction can also be defined by your inability to sense and respond to the presence of stool in your rectum.

Who does fecal impaction affect?

Fecal impaction occurs in all age groups but is most common in:

• The elderly.
• Children.
• People who have mobility issues.
• People with neuropsychiatric disorders including Alzheimer’s disease, Parkinson’s disease and dementia.

What's the difference between fecal impaction and constipation?

Constipation is when it's difficult to poop. Constant and untreated constipation causes fecal impaction, when there's a buildup of poop that you're unable to naturally pass.

How common is fecal impaction?

Nearly half of all elderly people in nursing homes have fecal impaction. This is the result of decreased mobility, neurological disorders and/or a side effect from medications.

How does fecal impaction affect my body?

Fecal impaction causes discomfort in your body due to gastrointestinal pressure from waste buildup. Discomfort from the pressure includes:

• Pain in your abdomen and/or lower back.
• Feeling like your abdomen is swollen (bloated).
• Having the need to poop but can’t.
• Stomachache like you’re full and/or have a loss of appetite.
• Lethargic or tired.

If left untreated, fecal impaction can cause ulcers, colitis or obstruction to your colon, which can be fatal.

What causes fecal impaction?

There are several factors that can contribute to fecal impaction, including:

• Chronic constipation.
• Slow operation of your colon (colonic hypomotility).
• Lack of fiber and water in your diet.
• Side effect of medication, such as opiates, antipsychotics and calcium channel blockers for high blood pressure.
• Illness or injury, such as colon conditions, spinal cord injury, Alzheimer’s disease, Parkinson disease and dementia.

What are the symptoms of fecal impaction?

The symptoms of fecal impaction include:

• Constipation.
• Discomfort and abdominal pain.
• Inability to eat.
• Frequent urination.

Severe symptoms of fecal impaction include:

• Nausea.
• Dehydration.
• Worsening psychosis or confusion.
• Diarrhea. (It may seem odd, but you may pass watery stool around hardened poop that you can’t pass.)
• Bleeding.

If you experience any severe symptoms, contact your healthcare provider immediately.

How is fecal impaction diagnosed?

Healthcare providers diagnose fecal impaction by a physical examination and a digital rectal examination. They look for a large amount of poop in your rectum. If your provider suspects your fecal impaction could be located in your colon, an abdominal X-ray can confirm its location.

How is fecal impaction treated?

Healthcare providers remove the blockage caused by fecal impaction in three steps:

1. Removing the poop (disimpaction).
2. Using fluids to remove waste from your colon (colon evacuation).
3. Suggesting you go to the bathroom at a regular time (bowel regimen).

Several treatment options are available for disimpaction depending on its severity and location. Your healthcare provider will monitor any treatments to confirm successful blockage removal.

These treatments include:

• Enema: During this procedure, you inject fluid into your rectum to loosen the impacted poop. This can be done in your healthcare provider’s office or at home.
• Physical assisted removal: A medical professional uses a gloved finger to manually remove poop from your rectum (digital disimpaction) or perform an abdominal massage to target the stuck stool.
• Laxatives: You can drink a polyethylene glycol (PEG) solution or use an over-the counter (OTC) laxative to cleanse your colon.
• Surgery: If you have severe fecal impaction, your healthcare provider will perform surgery, especially to target symptoms of bleeding due to a tear in your bowel (bowel perforation).

How soon after treatment for fecal impaction will I feel better?

After the blockage is removed, you should feel less to no discomfort or pain in your lower abdominal region. Taking preventative measures reduces the likelihood that your fecal impaction will return.

What are the complications of untreated fecal impaction?

Untreated fecal impaction could have serious, life-threatening complications, including:

• A hole in your colon (bowel perforation).
• Bleeding (hemorrhage).
• Uncontrollable bowel movements (fecal incontinence).
• Sores (ulcers).

How do I prevent fecal impaction?

Fecal impaction is preventable and can be avoided by:

• Increasing your fiber intake.
• Staying hydrated.
• Being active (light activity like a daily walk).
• Talking with your healthcare provider about medications you're taking that could cause fecal impaction.

What can I expect if I have fecal impaction?

Fecal impaction is preventable. It's best treated at the first sign of a problem passing poop regularly to reduce your risk of dangerous side effects. If you have chronic constipation, you may be at risk for fecal impaction. It’s a good idea to discuss how to prevent fecal impaction with your provider.

When should I see my healthcare provider for fecal impaction?

Contact your healthcare provider immediately if you're experiencing pain and discomfort and cannot poop, or have severe symptoms such as nausea, dehydration, confusion or bleeding. Addressing fecal impaction quickly can prevent dangerous, life-threatening side effects.

What questions should I ask my doctor?

• Am I constipated or do I have fecal impaction?
• Do any of my current medications cause fecal impaction?
• How severe is my fecal impaction?
• Will I need surgery to remove the fecal impaction?
• How can I prevent fecal impaction from happening again?

A note from Cleveland Clinic

While fecal impaction can be a painful disruption, making small lifestyle changes to prevent it can be beneficial to your overall health. Choose a fiber-friendly diet, stay hydrated and participate in low-intensity physical activities to keep stool moving through your bowels regularly. If constipation is a frequent occurrence, discuss treatment options with your doctor to alleviate the problem.