What is Fecal Impaction?
Fecal impaction happens when hardened stool gets stuck in the large intestine and can’t be removed through regular bowel movements. If not diagnosed and treated early, this can lead to the creation of fecoliths, which are essentially stone-like feces. Fecal impaction is a cause for increased health issues and can significantly decrease the quality of life, especially among older people.
What Causes Fecal Impaction?
Fecal impaction, which is a blockage in the intestines due to hardened stool, often happens in older people who are in the hospital or under special care. This condition can also be linked with other diseases like scleroderma (a disease causing hardening and tightening of the skin and connective tissues) and chronic kidney failure. It might also occur if there are changes in the normal structure of the body, like birth defects in the region near the end of the rectum or previous surgery on the intestines.
Older adults who take nonsteroidal anti-inflammatory medicines regularly, have shown higher instances of fecal impaction. If older patients in the hospital are given opioid medication (a type of strong painkiller), they could also end up with fecal impaction. This is particularly true for individuals who have a history of chronic constipation and are unable to move around in bed.
Risk Factors and Frequency for Fecal Impaction
Fecal impaction, a severe type of constipation, primarily affects elderly individuals, especially those in nursing homes. While it’s rarely an emergency, the condition can cause serious health issues if it worsens. It’s particularly prevalent among older women who are living in care facilities and dealing with related brain conditions. Let’s break down the main points:
- Fecal impaction often happens in elderly people and is rarely an emergency case.
- About 70% of elderly folks in nursing homes struggle with severe constipation.
- In around 7% of these cases, fecal impaction is detected by a physical examination.
- Older women in care facilities who also have brain disorders are at a higher risk.
- The condition can cause further health issues in elderly people if it’s not treated.
Signs and Symptoms of Fecal Impaction
People suffering from fecal impaction often have difficulty passing stools naturally and complain of complete constipation. They usually have a history of belly bloating and increasing abdominal discomfort or pain. A physical check-up might show a bloated belly. In lean or severely thin people, a firm mass of fecal matter may be felt along the colon. Sometimes, patients might also have varying or uncontrollable diarrhea. Diagnosing fecal impaction is primarily done based on these signs. A comprehensive understanding of bowel habits and a thorough physical check-up, including a rectal exam, are necessary steps.
Testing for Fecal Impaction
A digital rectal examination refers to a procedure where a doctor uses a gloved, lubricated finger to check for any abnormalities in the lower rectum. This is often the first step to identify a condition known as fecal impaction, which is the buildup of hardened bowel movements that block your colon or rectum. If a rectal exam doesn’t detect fecal impaction or solid stool masses, it’s possible the blockage is further up in the bowel or there could be other issues to consider, such as a stricture, which is an abnormal narrowing of a passage in the body, or a volvulus, which is an abnormal twisting of the colon.
The most helpful and frequently used type of scan for this condition is a CT scan of the abdomen with oral or rectal contrast. A contrast is a special dye that helps to visualize certain areas of the body better. Alternatively, a plain x-ray of the abdomen can sometimes show an overload of stool in the colon, along with dilation or stretching of the section upstream from the impaction site.
In rare cases, a contrast enema or a sigmoidoscopy may be required. A contrast enema is a procedure where a contrast dye is introduced into the colon via the rectum, while a sigmoidoscopy is a procedure used to view the inside of the lower part of the colon. These techniques are typically used in patients who have no history indicating a disease of the colon.
Treatment Options for Fecal Impaction
Fecal impaction, which is a hard mass of stool that can’t be passed naturally, can be treated by manually removing the stool mass or by using medication that softens the stool like suppositories or enemas.
In many cases, the manual removal of the hard stool mass is necessary. This process involves using enough lubrication to gently remove the stool with the index finger. Sometimes, using an anoscope and suction can assist the procedure. Most patients immediately feel relief after this procedure is finished.
Depending on where the hard stool is, different medications or techniques may be used. If the issue is further down the colon, enemas and suppositories can be useful. The enema involves inserting a tube past the stool and flushing it out with fluids like water and stool softening medications. It’s essential to use small amounts so the patient is not uncomfortable. The doctor may also gently massage the stomach to assist with the process, and this may need to be done a few times until all hard stool has been removed. If a patient feels pain during this procedure, it needs to be stopped and reevaluated.
If the stool is stuck further up the colon, a laxative like polyethylene glycol can be used. It may take a few liters over several hours before it becomes effective. If it causes abdominal cramps or nausea, it should not be continued.
Sometimes, hard stool can become even harder after a barium study, since barium isn’t water-soluble. This is most likely to happen in patients who already have issues with their lower gastrointestinal tract. To avoid this, patients should drink extra fluids, and sometimes a different type of laxative might need to be used. If the issue has escalated to a perforation in the colon or bowel, surgery would be required.
In more severe cases, such as patients who have had rectal surgery, manual removal of the stool might be necessary in the operating room. These patients will need to change lifestyle habits to prevent constipation, like drinking plenty of water, exercising, eating high fiber foods, and potentially undergoing anesthesia to relax the area around the rectum to remove the hard stool.
What else can Fecal Impaction be?
When doctors consider health conditions related to bowel movements, they may look at:
- Constipation
- Inspissated stool syndrome, a condition where the stool becomes hard and difficult to pass
What to expect with Fecal Impaction
Fecal impaction is a common but preventable issue often seen in elderly individuals in hospitals and other care facilities. The most effective treatment is to stop it before it happens. To do this, the cause of constipation should be found early on and properly managed.
Patients should be educated about personal habits and the importance of a healthy diet in preventing fecal impaction. Unfortunately, recurring fecal impaction is a common problem for elderly and institutionalized patients. These patients sometimes need to seek help from emergency departments because the symptoms can resemble those of more severe intestinal problems.
Possible Complications When Diagnosed with Fecal Impaction
Possible complications of fecal impaction include:
- Stercoral Perforation (a tear in the bowel due to the hard, stuck stool or use of an enema)
- Discomfort in the rectum
- Inability to control bowel movements (fecal incontinence)
- Inability to control urine (urinary incontinence)
Recovery from Fecal Impaction
Once the blockage in the bowel, also known as fecal impaction, has been addressed, we should investigate what caused it in the first place. Following a bowel preparation, which cleans your intestines, a barium enema or a colonoscopy may be performed. These are types of tests that allow your doctor to look inside your colon for any problems or abnormalities.
Further, tests to check the functioning of your thyroid gland and your body’s metabolism may also be needed. The thyroid gland controls how your body uses energy, while metabolism refers to all the chemical reactions that help maintain life in your body.
Other areas we’ll need to address include depression, a lack of physical activity, and poor access to toilets. All of these can play a part in bowel health and might be contributing to bowel blockage.
Preventing Fecal Impaction
Improving movement and physical activity can be very beneficial for patients as it helps maintain overall health. It’s recommended to increase the water intake, as staying hydrated is essential for bodily functions such as circulation and digestion. Including more fiber in your diet is also necessary, as it promotes healthy digestion and helps prevent conditions like constipation.
