What is Stercoral Colitis?
Stercoral colitis is a rare type of inflammation in the colon (the longest part of the large intestine) that happens when hardened poop builds up in the body. This buildup can cause the colon to stretch and eventually form what’s called a fecaloma (hard, dry stool that stays stuck in the rectum). Fecalomas can create harmful pressure spots and even create holes in the colon, while the stretching and increased pressure inside the colon can lead to reduced blood supply and cause a condition called ischemic colitis.
Sores, or ulcers, can then appear in multiple areas of the colon. They occur most often in the large curved part of the colon (the sigmoid colon) and the rectum. When such an ulcer causes a hole, or perforation, in the colon, it can be severe, with death rates of 32% to 60%. Stercoral colitis is usually found in patients with a long history of constipation, elderly patients with dementia, those living in nursing homes or who are bedridden, and sometimes, young patients with mental health conditions. Long-standing constipation is the biggest risk factor for developing this condition.
What Causes Stercoral Colitis?
Stercoral colitis happens when chronic constipation (long-term difficulty excreting stools) causes fecal impaction (hardened stool that becomes stuck), leading to stretching and misshaping of the colon (part of the large intestine), and producing hard, dehydrated lumps of fecal material known as fecalomas. These fecalomas can get stuck in parts of the colon, usually in the rectosigmoid colon, a part located just before the rectum. This can result in pressure sores due to lack of blood supply, and over the course of time, this can cause a part of the colon to die off and create a hole, or perforation.
About 27% of patients develop multiple sores. Moreover, the severe stretching of the colon can also put pressure on the blood vessels in the bowel wall, which can cause swelling, inflammation (the body’s response to injury or infection), and lack of blood supply to parts of the colon. The main concerns associated with this condition are a colonic perforation (a hole in the colon) and ischemic colitis (damage to the colon due to reduced blood flow).
The risk factors for developing chronic constipation can be numerous and varied. These include a diet low in fiber, genetics, behaviors, certain medications, and physical conditions which influence the movement of feces through the colon and the body’s absorption of fluids.
Risk Factors and Frequency for Stercoral Colitis
Stercoral colitis is an uncommon illness, not much discussed in medical literature. This disease typically affects older people, individuals bound to their beds due to dementia or stroke, chronic opioid users, and sometimes younger people with mental health issues. Diagnosis of stercoral colitis can be difficult due to neurological and psychiatric complications which might disguise the symptoms, so it’s essential to remember this condition when examining these patients.
- Most elderly patients, dementia or stroke patients, chronic opioid users, and even young patients with mental issues can contract stercoral colitis.
- Other health issues can often hide the symptoms which can delay the diagnosis.
Chronic constipation is a typical problem among the elderly, affecting one-third of adults aged 60 to 110. Several factors contribute to this, like tooth loss or ill-fitting dentures, improper diet, inadequate fluid intake, lack of exercise, and regular consumption of various medicines. Additionally, it’s more commonly observed in women than in men.
- Chronic constipation is common in older adults ranging from 60 to 110.
- This can be caused by denture problems, poor diet, not drinking enough fluids, not enough physical activity, and frequent use of medications.
- Women tend to experience chronic constipation more often than men.
Furthermore, children, particularly during weaning, toilet training, and transition to school may also experience chronic constipation. If a child has a history of constipation, they could potentially develop stercoral colitis.
- Children may have chronic constipation during weaning, toilet training, and their transition to school.
- A history of constipation in a child can lead to stercoral colitis later.
Signs and Symptoms of Stercoral Colitis
Stercoral colitis is a disease often seen in patients who have a history of chronic constipation. This constipation can be due to certain neurological, mental, or metabolic conditions, such as diabetic neuropathy. It’s important to know that it’s more common in older adults and people with dementia. Getting a complete medical history can be challenging in these cases, so doctors need to be vigilant in spotting the signs. The usual symptoms of stercoral colitis are belly discomfort, cramps, and fever.
During a physical exam, these patients often have a tender, swollen belly. Unlike an intestinal blockage, people with stercoral colitis typically will still have some stool in the rectal area. They may also pass small amounts of stool. In extreme cases, a patient’s condition can deteriorate rapidly, leading to inflammation in the lining of the stomach, septic shock which is a severe bloodstream infection, or damage to multiple organs if the colon has perforated or has not been getting enough blood flow.
Testing for Stercoral Colitis
If a doctor suspects a patient has stercoral colitis, several lab tests and imaging studies will likely be conducted. These tests may show signs of infection or inflammation, such as an increase in white blood cells or other indicators of inflammation in the body. Also, they may show an increase in lactic acid and an imbalance in the body’s pH level, which can signal possible damage to the bowel.
However, these tests alone won’t necessarily confirm or rule out stercoral colitis, as the results aren’t specific to this condition. This is where imaging comes in. Specifically, a CT scan of the abdomen and pelvis, using a special dye if the patient’s kidney function is sufficient, can be very effective at detecting stercoral colitis.
The CT scan can show specific signs that point to this condition, such as fecal blockage, a widening of the colon (especially the rectosigmoid colon which is towards the end of the colon), and a thickening of the bowel wall, commonly found next to fecal blockage. The thickening is generally due to swelling or ulceration caused by pressure damage. The CT scan can also reveal bubbles of gas or an abscess, indicating that a bowel rupture has already happened.
In certain cases, the diagnosis may need to be confirmed through surgery and histologic studies, which examine tissues under a microscope. Notably, one small study found that specific CT scan findings and the length of the affected colon segment longer than 40 cm were most correlated with patient death.
Treatment Options for Stercoral Colitis
For patients without signs of inflammation or infection in the lining of the abdomen (peritonitis), treatment usually includes the manual removal of impacted stool from the rectum or a similar procedure using an endoscope (a thin, flexible tube with a light and camera at its end). A bowel regimen is established, usually consisting of changes to the diet and use of medications to help stimulate bowel movements. Pain relief medications should be given carefully, avoiding strong painkillers like opioids which can make the bowel less active.
In some cases, if the doctors suspect a possible need for surgery, patients may be asked to avoid eating or drinking anything. This is known as being “nil per os” or NPO.
If there’s a sign of severe infection or shock – a severe drop in blood pressure leading to organ failure, patients may need to be given IV fluids and a wide range of antibiotics directly into their bloodstream to fight against bacteria.
In some serious situations, such as when the bowel is perforated, when a large portion of the bowel is affected, or when the usual treatments aren’t working, surgery may be necessary. The operation could involve removing the affected part of the bowel, creating a new exit for the intestines through the abdomen (colostomy), and creating a small, temporary pouch within the colon (Hartmann pouch).
Treating chronic constipation can involve changes to the diet, such as incorporating more fiber, fruits, and fluids. For people who have severe constipation leading to large, hard, dry stools that are difficult or painful to pass (fecal impaction) or inflammation of the colon due to the pressure from these hard stools (stercoral colitis), they should also be given medications to help prevent constipation in the future. These may include osmotic laxatives, which work by retaining water in the stool to soften it and stimulate the bowel, or stimulant laxatives, which stimulate the muscles in the intestines to push the stool out. These are usually the first choices for treating constipation.
What else can Stercoral Colitis be?
There are several conditions that might look like appendicitis at first glance. Therefore, it’s crucial to consider them all to make an accurate diagnosis. These conditions include:
- Diverticulitis
- Large bowel obstruction
- Ulcerative colitis
- Infectious colitis
- Malignancy or cancer
- Bowel perforation
- Acute mesenteric ischemia (lack of blood supply to the intestines)
- Intra-abdominal abscess (a pocket of infection inside your abdomen)
What to expect with Stercoral Colitis
The success of treating this condition hinges on catching it early and treating it quickly. The factors that increase the risk of death the most are a rupture in the bowel (32% to 59% chance of death), a large part of the bowel being affected (>40 cm), and a lack of blood flow to the bowel. The latter is shown by high levels of lactic acid in the blood or signs of severe bacterial infection (septic shock).
No relevant difference related to the patient’s age or sex on the risk of death has been noted. However, this could be because stercoral colitis, the condition in question, is not well-recognized and rarely reported in medical studies.
Possible Complications When Diagnosed with Stercoral Colitis
The most dangerous complication of stercoral colitis, a type of bowel inflammation, is a perforation or a hole in the colon wall. This condition is considered a significant indicator of the risk of death. Other complications can include bloodstream infection, systemic infection (septic shock), ischemic colitis (restricted blood flow to the colon), and difficulty in passing urine due to compression by the swollen bowel.
Multiple organ failure can occur as a result of the body’s reaction to the infection and the inadequate blood flow to various organs. Kidney failure may happen due to compression and blockage of the pathways that carry urine from the kidneys to the bladder (ureters).
For those patients who don’t undergo surgery, there is a risk of recurring ulcers and possible perforation in the affected colon segments. Patients who do undergo surgery can experience leakage from the connection site between two parts of the colon (anastomosis) that may eventually lead to sepsis, a severe infection that can spread across the body.
Here is a list summarizing the potential complications of Stercoral Colitis:
- Perforation of the colon
- Bloodstream infection (sepsis)
- Systemic infection (septic shock)
- Ischemic colitis (restricted blood flow to the colon)
- Difficulty passing urine due to compression by the swollen bowel
- Multiple organ failure due to infection and inadequate blood flow
- Kidney failure from blockage of urine pathways
- Risk of recurring ulcers and possible perforation without surgery
- Risk of leakage from surgical connection in the colon and resulting sepsis with surgery.
Recovery from Stercoral Colitis
If you are diagnosed with this condition, your treatment will depend on your specific symptoms. If surgery isn’t necessary, your doctor will keep a close eye on your abdominal symptoms, and regularly check your blood test results (white blood cell count, lactic acid levels, and acute phase reactants) and repetitive imaging to make sure there’s no need for surgery. For patients with stercoral colitis (a type of colon inflammation) that is accompanied by a perforation or tear, emergency surgery is needed to remove the affected portion of the colon. These patients are at a very high risk of severe health problems and need to be monitored closely in the intensive care unit after surgery.
Preventing Stercoral Colitis
If you suffer from long-lasting constipation, it’s crucial to learn about eating habits that can help you go to the bathroom more regularly and prevent health issues like stercoral colitis, which is inflammation in the colon due to built-up stool. If changing your lifestyle and diet doesn’t alleviate your constipation, medications and other treatments could be an option.
If you experience complications from constipation, such as fecal impaction (a solid, immovable lump of stool that collects in your rectum) or stercoral colitis, it’s important to regularly consult with a dietitian and a doctor specializing in the digestive system (gastroenterologist).
Certain exams like a colonoscopy (which examines your colon), anorectal manometry (which checks the coordination of the muscles used to move your bowels), a barium study (which uses a special dye to show the inside of your intestines on an X-ray), and colonic transit (which measures how long it takes stool to move through your colon), can be useful in finding out if there’s another reason causing your constipation.
Finally, reviewing any medications that you’re currently taking at home can also help identify if any of them are causing your constipation.