Fecal impaction - Wikipedia, the free encyclopedia

7/17/15, 21:14

Fecal impaction
From Wikipedia, the free encyclopedia

A fecal impaction is a solid, immobile

bulk of human feces that can develop
in the rectum as a result of chronic
constipation. A related term is fecal
loading which refers to a large volume
of stool in the rectum of any

Fecal impaction

consistency.[1]

Contents
1 Signs and symptoms
2 Causes
3 Prevention
4 Treatment
5 References
6 Further reading

Plain abdominal X-ray showing a huge fecal impaction extending from the
pelvis upwards to the left subphrenic space and from the left towards the right
flank, measuring over 40 cm in length and 33 cm in width.

Signs and symptoms

Symptoms include chronic
constipation. There can be fecal
incontinence and paradoxical or
overflow diarrhea (encopresis) as liquid
stool passes around the obstruction.
Complications may include necrosis
and ulcers of the rectal tissue.
Abdominal pain and bloating could
also be present depending on the
severity of the condition. Loss of
appetite can also occur.

Classification and external resources

Specialty

Gastroenterology

ICD-9-CM

560.32 (http://www.icd9data.com/getICD9Code.ashx?
icd9=560.32)

DiseasesDB 9450 (http://www.diseasesdatabase.com/ddb9450.htm)

MedlinePlus 000230
(http://www.nlm.nih.gov/medlineplus/ency/article/000230.htm)
MeSH

D005244 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?
field=uid&term=D005244)

Causes
There are many possible causes; for example, physical inactivity, not eating enough (particularly of fiber), and
not drinking enough water. Medications such as opioid pain relievers (suboxone, methadone, codeine,
oxycodone, hydrocodone, etc.) and certain sedatives that reduce intestinal movement may cause fecal matter to
become too large, hard and/or dry to expel. Specific diseases or conditions, such as irritable bowel syndrome,
neurological disorders, diabetes, and autoimmune diseases such as amyloidosis, celiac disease, lupus, and
https://en.wikipedia.org/wiki/Fecal_impaction

Page 1 of 4

Fecal impaction - Wikipedia, the free encyclopedia

7/17/15, 21:14

scleroderma can cause constipation. Hypothyroidism can cause chronic constipation because of sluggish,
slower, or weaker colon contractions. Iron supplements or increased blood calcium levels are also potential
causes. Spinal cord injury is a common cause.
Manual removal of a fecal impaction is often required with obese patients in traction, after a barium enema, and
in poorly hydrated older adults.

Prevention
Reducing opiate-based medication (when possible, tolerable, and safe; prescription medication changes should
be done under the supervision of a physician), an adequate intake of liquids (water) and dietary fiber and daily
exercise.

Treatment
The treatment of fecal impaction requires both the remedy of the impaction and treatment to prevent future
recurrences. Decreased motility of the colon results in dry, hard stools that in the case of fecal impaction
become compacted into a large, hard mass of stool that cannot be expelled from the rectum.
Various methods of treatment attempt to remove the impaction by softening the stool, lubricating the stool, or
breaking it into pieces small enough for removal. Enemas and osmotic laxatives can be used to soften the stool
by increasing the water content until it is soft enough to be expelled. Osmotic laxatives such as magnesium
citrate work within minutes - 8 hours for onset of action, and even then they may not be sufficient to expel the
stool.
Osmotic laxatives can cause cramping and even severe pain as the patient's attempts to evacuate the contents of
the rectum are blocked by the fecal mass. Polyethylene glycol (PEG 3500) may be used to increase the water
content of the stool without cramping; however, since it may take 24 to 48 hours for it to take effect, it is not
well suited to cases where the impaction needs to be removed immediately due to risk of complications or
severe pain. Enemas (such as hyperosmotic saline) and suppositories (such as glycerine suppositories) work by
increasing water content and stimulating peristalsis to aid in expulsion, and both work much more quickly than
oral laxatives.
Because enemas work in 215 minutes, they do not allow sufficient time for a large fecal mass to soften. Even if
the enema is successful at dislodging the impacted stool, the impacted stool may remain too large to be expelled
through the anal canal. Mineral oil enemas can assist by lubricating the stool for easier passage. In cases where
enemas fail to remove the impaction, polyethylene glycol can be used to attempt to soften the mass over 2448
hours, or if immediate removal of the mass is needed, manual disimpaction may be used. Manual disimpaction
may be performed by lubricating the anus and using one gloved finger with a scoop-like motion to break up the
fecal mass. Most often manual disimpaction is performed without general anaesthesia, although sedation may
be used. In more involved procedures, general anaesthesia may be used, although the use of general anaesthesia
increases the risk of damage to the anal sphincter. If all other treatments fail, surgery may be necessary.
Individuals who have had one fecal impaction are at high risk of future impactions. Therefore, preventative
treatment should be instituted in patients following the removal of the mass. Increasing dietary fiber, increasing
fluid intake, exercising daily, and attempting regularly to defecate every morning after eating should be
https://en.wikipedia.org/wiki/Fecal_impaction

Page 2 of 4

Fecal impaction - Wikipedia, the free encyclopedia

7/17/15, 21:14

promoted in all patients.

Often underlying medical conditions cause fecal impactions; these conditions should be treated to reduce the
risk of future impactions. Many types of medications (most notably opioid pain medications, such as codeine)
reduce motility of the colon, increasing the likelihood of fecal impactions. If possible, alternate medications
should be prescribed that avoid the side effect of constipation.
Given that all opioids can cause constipation, it is recommended that any patient placed on opioid pain
medications should be given medications to prevent constipation before it occurs. Daily medications can also be
used to promote normal motility of the colon and soften stools. Daily use of laxatives should be avoided by
most individuals as it can cause the loss of normal colon motility. However, for patients with chronic
complications, daily medication under the direction of a physician may be needed.
Polyethylene glycol 3350 can be taken daily to soften the stools without the significant risk of adverse effects
that are common with other laxatives. In particular, stimulant laxatives should not be used frequently because
they can cause dependence in which an individual loses normal colon function and is unable to defecate without
taking a laxative.[2] Frequent use of osmotic laxatives should be avoided as well as they can cause electrolyte
imbalances.

References
1. (UK), National Collaborating Centre for Acute Care (2007). Faecal incontinence the management of faecal incontinence
in adults. London: National Collaborating Centre for Acute Care (UK). ISBN 0-9549760-4-5.
2. Joo JS, Ehrenpreis ED, Gonzalez L et al. (June 1998). "Alterations in colonic anatomy induced by chronic stimulant
laxatives: the cathartic colon revisited" (http://meta.wkhealth.com/pt/pt-core/templatejournal/lwwgateway/media/landingpage.htm?issn=0192-0790&volume=26&issue=4&spage=283). Journal of Clinical
Gastroenterology 26 (4): 2836. doi:10.1097/00004836-199806000-00014 (https://dx.doi.org/10.1097%2F00004836199806000-00014). PMID 9649012 (https://www.ncbi.nlm.nih.gov/pubmed/9649012).

Further reading
Wrenn K (September 1989). "Fecal impaction". The New England Journal of Medicine 321 (10): 65862.
doi:10.1056/NEJM198909073211007 (https://dx.doi.org/10.1056%2FNEJM198909073211007).
PMID 2671728 (https://www.ncbi.nlm.nih.gov/pubmed/2671728).
Dugdale, David C. (January 31, 2011). "Fecal impaction"
(http://www.nlm.nih.gov/medlineplus/ency/article/000230.htm). A.D.A.M., Inc.
Gattuso JM, Kamm MA, Halligan SM, Bartram CI (April 1996). "The anal sphincter in idiopathic
megarectum: effects of manual disimpaction under general anesthetic". Diseases of the Colon and Rectum
39 (4): 4359. doi:10.1007/bf02054060 (https://dx.doi.org/10.1007%2Fbf02054060). PMID 8878505
(https://www.ncbi.nlm.nih.gov/pubmed/8878505).
Retrieved from "https://en.wikipedia.org/w/index.php?title=Fecal_impaction&oldid=671172206"
Categories: Gastroenterology Feces
This page was last modified on 12 July 2015, at 23:20.
https://en.wikipedia.org/wiki/Fecal_impaction

Page 3 of 4

Fecal impaction - Wikipedia, the free encyclopedia

7/17/15, 21:14

Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may
apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia is a registered
trademark of the Wikimedia Foundation, Inc., a non-profit organization.

https://en.wikipedia.org/wiki/Fecal_impaction

Page 4 of 4