FECAL IMPACTION

General Information

DEFINITION--A severe form of acute constipation in which a large mass of feces cannot be passed. Fecal impaction is not a serious condition, but it complicates other illnesses.

BODY PARTS INVOLVED--Lower colon; rectum.

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

SIGNS & SYMPTOMS

• Absence of normal bowel movements.
• Sense of fullness in the rectum, but inability to pass stool.
• Lack of urinary control.
• A firm mass in the lower left abdomen (sometimes).
• Pain or cramps (sometimes). Impaction often develops slowly without discomfort.
• Thin, watery discharge from the rectum.

CAUSES

• Rectal disorders that make normal bowel movements uncomfortable, such as painful hemorrhoids or anal fissure.
• Rectal or colon tumors.
• Barium that is swallowed for x-rays of the intestinal tract.
• Loss of nerve supply to the colon or rectum, as with a spinal-cord injury.
• Insufficient fiber and liquid in the diet.

RISK INCREASES WITH

• Bed rest for any condition, such as a recent heart attack, surgery or fracture.
• Back disorders with nerve pressure.
• Decreased fluid and fiber intake.
• Chronic or long-term use of laxatives.
• Use of some drugs, such as narcotic pain killers, antiparkinsonism drugs, atropine, phenothiazines or tricyclic antidepressants.

HOW TO PREVENT

• If confined to bed, drink extra fluids and increase consumption of dietary fiber.
• If simple constipation develops, use a mild laxative, such as milk of magnesia, a stool softener or an enema.
• Set aside a regular time each day for bowel movement (within an hour after breakfast is best). Don't try to hurry. Sit at least 10 minutes.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam, including a rectal exam, by a doctor.

APPROPRIATE HEALTH CARE

• Self-care.
• Doctor's treatment to remove feces by enema or manually.

POSSIBLE COMPLICATIONS

• Persons who have had a recent (within 1 week) heart attack may suffer fatal rupture of the heart muscle while straining to pass a fecal impaction.
• Rectal prolapse (protrusion outside the body).
• Aggravation of hemorrhoids.

PROBABLE OUTCOME--Usually curable with treatment, but recurrence is common unless the underlying cause is removed.

How To Treat

GENERAL MEASURES--

• If your doctor prescribes it, use an oil-retention enema before and after manual removal of the impaction. Follow instructions on the package.
• See Constipation (in Illness section) for suggestions to improve bowel habits.

MEDICATION--After removal of the impaction, your doctor may prescribe laxatives or stool softeners.

ACTIVITY--No restrictions. Be as active as possible. Good physical fitness improves bowel function.

DIET--

• Eat a normal, well-balanced diet high in fiber (see Appendix).
• Drink at least 8 glasses of fluid each day.

Call Your Doctor If

• You have symptoms of a fecal impaction.
• Your normal bowel pattern changes.
• You cannot pass feces while under treatment for other conditions.