Stercoral Colitis

Stercoral colitis is inflammation inside your colon caused by fecal impaction (hard, impacted stool). Stercoral means feces-related. Colitis means inflammation in your colon (irritation, pain and swelling). It’s a rare but serious complication of severe constipation.

When poop can’t pass, it backs up in your colon and becomes increasingly hard and dense. As it continues to build up, it strains against your intestinal walls and compresses the blood vessels. This is one way it can cause inflammation and swelling in your colon walls.

Impacted feces can also form into distinct, hardened masses called fecalomas. These masses can put more intense and focused pressure on one area of your intestinal walls. This can lead to more serious and even life-threatening complications, including:

• Ischemia: Pressure may cut off blood supply to your colon, causing ischemic colitis. This can cause tissue death (necrosis), which can lead to gangrene and widespread infection.
• Ulceration: Pressure sores (ulcers) inside your intestine could cause bleeding or even wear a hole through your intestinal wall (perforation). This could cause an infection in your body.

If you already have fecal impaction, symptoms of colitis may not seem unusual or alarming. But the implications are serious. Stercoral colitis means your condition has reached a new, critical stage. You need urgent care to prevent worse complications.

Stercoral colitis symptoms

With fecal impaction, you probably already have some abdominal pain. But with stercoral colitis, you might feel it more in one spot, especially in your lower abdomen on the left side. This is the end of your colon. Most fecalomas form here because it’s narrower, and your poop is more solidified here.

Symptoms may include:

• Abdominal pain, especially on the lower left side
• Abdominal distension (swelling)
• Abdominal tenderness to the touch
• Fever
• Cramps
• Blood in your stool

Some people don’t notice new symptoms when they develop stercoral colitis. You might think your symptoms are just from your ongoing constipation. Or you might have learned to ignore them. But fever or bleeding are important warning signs. If you develop these, call your healthcare provider right away.

Stercoral colitis causes

Stercoral colitis happens when impacted stool in your large intestine irritates and inflames the tissues. One way it does this is by putting pressure on your intestinal walls and compressing the blood supply. Hardened masses called fecalomas may put focal pressure in one area. Fecalomas can also cause ulcers. These are wounds that trigger inflammation. Your body creates inflammation to try and repair the injured tissues.

Risk factors

Risk factors for stercoral colitis are the same as those for chronic constipation. They include:

• Being immobile or hospitalized
• Bowel obstruction or pseudo-obstruction
• Gastrointestinal dysmotility disorders
• Opioid use

Stercoral colitis complications

Stercoral colitis is a warning sign that fecal impaction has reached a life-threatening stage. At this stage, it can lead to widespread infection and sepsis in several ways.

Building pressure within your colon may cut off the blood supply. This can cause tissue death and lead to gangrene. Pressure may also cause ulcers. These may penetrate all the way through your intestine. That can allow the bacteria inside to escape into your body.

Infection in your abdominal cavity (peritonitis) can quickly spread to your bloodstream (septicemia) and through your body. When this happens, you’re at risk of sepsis. This is an extreme immune system reaction to the infection. Septic shock can lead to organ failure and death.

Stercoral colitis diagnosis

Your healthcare provider will review your symptoms and health history. Then, they’ll perform a physical exam. This may include a digital rectal exam. They’ll also run blood tests to look for certain signs and clues. Symptoms of stercoral colitis look like those of many other conditions. So, they might have to rule these out.

It will take radiology imaging to see the evidence of stercoral colitis inside your intestine. This usually involves a CT scan. Imaging can reveal fecal impaction and fecalomas, as well as signs of inflammation. Imaging may also show evidence of complications like perforation, ischemia or infection in your abdominal cavity.

How do you treat stercoral colitis?

To relieve stercoral colitis, your healthcare provider must clear the impacted stool from your bowel. They have several different ways of doing this. If you don’t show any signs of serious complications yet, they’ll start with the least invasive methods. They’ll progress to procedures if necessary. Methods include:

• Digital disimpaction
• Enema
• Laxatives
• Endoscopy

If you do have complications, you might need emergency treatments, like:

• IV fluids and antibiotics
• Laparotomy

What is the outlook after stercoral colitis treatment?

Stercoral colitis is serious. The outcome depends on how soon you get treatment. If you have complications like ischemia or perforation, there’s a significant risk of sepsis and death. There’s also a chance you’ll need surgery on your bowel.

On the other hand, if you have an uncomplicated case, your healthcare provider might be able to resolve it with noninvasive treatments like enemas and laxatives.

In either case, you can expect to spend a few days in the hospital. Once the emergency is over, your healthcare team will develop a new, long-term treatment plan to prevent it from happening again.

What can I do to prevent stercoral colitis?

If you have long-term (chronic) constipation, or you care for an elder or child who has it, it’s important to address it with a healthcare provider. Go ahead and try home remedies first. But if those don’t work, don’t let it continue. Constipation is common, but it can become serious. This is especially true if you have a medical condition that affects your bowels, or if you take certain medications that cause constipation.

Your provider will help you develop a plan to keep your bowels healthy and functional. This may include things like:

• Getting more fiber in what you eat
• Adjusting your medications and supplements
• Treating underlying conditions