Fecalith & Fecaloma

A fecalith is a small, stone-like lump of hardened poop (feces). It forms when poop dries out and becomes firm and solid. Fecaliths usually develop in narrow spaces, like your appendix (appendicolith). They can block your appendix, which can cause appendicitis. They can also get stuck in small pouches (diverticula) in your large intestine (colon). This can lead to diverticulitis.

A fecaloma is a giant, rock-hard fecalith. Fecalomas most often build up in your rectum or colon. They can press on nearby organs like your bladder and kidneys as they fill and expand large portions of your colon. The largest documented fecaloma was 1.5 feet long and almost a foot wide. Fecalomas can lead to life-threatening complications. They’re the most severe form of fecal impaction.

Fecaliths are like tiny pebbles made of poop. Fecalomas are like large boulders of poop. You can prevent both by taking note of new symptoms. It’s also important to treat constipation before poop builds up.

Types of fecaliths

Healthcare providers sometimes sort fecaliths based on what type of material they contain. These include:

• Phytobezoar: Mostly made up of plant fibers, seeds or skins from fruits and vegetables. They form when you eat a lot of fiber, but your colon doesn’t move poop well. This allows plant matter to harden.
• Trichobezoar: Made up of swallowed hair. They usually form in your stomach. If they form in your colon, you may have a medical condition like pica.
• Lactobezoar: Made up of milk curds or formula residue. They can form in infants who drink a lot of milk formula.
• Pharmacobezoar: Made up of medications that don’t dissolve well in your GI tract. Medications like iron tablets and certain antacids can clump up and harden.

Fecalith and fecaloma symptoms

You may not notice any fecalith symptoms unless it causes a blockage. When symptoms do occur, they’re usually related to the location of the fecalith. For example:

• A fecalith in your appendix may cause sudden, sharp abdominal pain.
• A fecalith in a diverticulum in your colon may cause abdominal pain, fever or tenderness.

Symptoms of a fecaloma may begin with constipation and minor discomfort. Over time, you may also have:

• A swollen belly and bloating
• Severe abdominal pain and cramping
• Loose, liquid poop that leaks out
• Nausea and vomiting
• Feeling like you didn’t finish pooping
• Trouble peeing or peeing often

Fecalomas commonly affect people who are nonverbal or have intellectual disabilities. They often can’t tell you about their physical symptoms. So you may notice changes in their behavior and mood. These may include:

• Irritability
• Anxiety
• Anger
• Confusion
• Tiredness
• Trouble sleeping
• Loss of appetite

Fecalith causes

The main cause of fecaliths is chronic constipation. This happens when you poop less often. That causes your poop to harden, making it difficult to poop. Constipation can occur due to:

• Lack of physical activity
• Not getting enough fiber
• Dehydration
• Changes in your regular routine
• Stress

Other causes of fecaliths include:

• Certain medications, like opioids and antipsychotics
• Intellectual disabilities
• Psychiatric disorders
• Anatomic abnormalities, like Hirschsprung’s disease
• Bowel blockages from untreated smaller fecaliths
• Slow movement of poop through your colon
• Trouble sensing fullness or pressure from poop in your rectum

Risk factors

Fecaliths and fecalomas are more common in people age 65 and older. They also affect people with chronic conditions. These may include underlying GI issues like blockages and abnormal narrowing. Fecalomas can also occur in children, but are less common. Other risk factors include:

• Constipation often
• More than one untreated fecal impaction
• Time spent in a hospital or mental health center
• Previous belly surgeries

Complications of this condition

Possible complications of fecalomas include:

• Bowel obstruction (blockage)
• Perforation of your colon (hole in your intestine)
• Bacterial infection
• Urinary tract infection
• Colon swelling
• Sores or tissue death
• Blood flow issues
• Shock or severe illness

How doctors diagnose this condition

A healthcare provider will ask about your symptoms and medical history. They’ll also perform a physical examination, including a digital rectal exam. With this exam, your provider inserts a gloved finger into your rectum. They may also press on your belly.

Your provider will also request X-rays or a CT scan of your abdomen. Providers rely heavily on CT scans for people who are nonverbal or have intellectual disabilities. In children, the provider will sometimes use a fecalith ultrasound.

How are fecaliths and fecalomas treated?

Small fecaliths that don’t cause any symptoms may not need treatment. If the fecalith leads to a complication like appendicitis or diverticulitis, your provider will treat those conditions.

Fecaloma treatment focuses on safely removing the hardened poop. It also involves preventing it from coming back. Management depends on your overall health and how severe your condition is. If possible, your healthcare provider will use nonsurgical methods to remove the fecalith. These may include:

• Manual removal of the poop: A provider will use their gloved hand to remove the poop during a rectal exam.
• Oral medications: These include medicines you take by mouth. Examples include laxatives and stool softeners.
• Rectal medications: You insert other medications into your rectum. These include suppositories and enemas.
• Daily routine: Make a plan that includes eating fiber, drinking water and taking medications.

If nonsurgical treatments don’t work, your provider may perform a colonoscopy. They can use small tools to break up and remove the fecaloma during the procedure.

In severe cases, surgery may be necessary. One fecaloma surgery option removes the affected part of your colon. Your provider may make a temporary opening for poop to pass (ostomy).

Recovery time

Recovery from a fecaloma can take a few days to a week in the hospital. Pain and swelling usually improve quickly after your provider removes the poop. After you leave the hospital, you’ll need to keep up with a daily bowel routine. Your provider will want to see you for follow-ups. They want to make sure you’re recovering properly.

Recovery also depends on your overall health, age and other medical conditions. Some people may need ongoing support from caregivers to help manage their bowel habits. This especially includes those with intellectual disabilities.

When should I see my healthcare provider?

After a fecaloma removal, your provider will want to see you for follow-up. This will usually be within a few days to a week. But you should see them sooner if you notice:

• Severe or worsening belly pain
• Fever or chills
• Nausea or vomiting
• Trouble passing gas or poop
• Blood in your poop
• Swelling or ongoing discomfort

What is the outlook for someone with a fecaloma?

Your outlook is usually good with early diagnosis and immediate treatment. Most people recover fully after their provider removes the poop. You’ll have to develop a strong bowel routine. This is to make sure it doesn’t come back. If you don’t get treatment right away, serious complications can occur.

Can fecaliths and fecalomas be prevented?

You can prevent some fecaliths and fecalomas from forming. Steps you can take include:

• Eat more fiber.
• Drink plenty of water.
• Get regular physical activity.
• Avoid medications that can cause constipation.
• Seek medical attention if you experience chronic constipation.