Dealing with fecal impaction
A frustrating and sometimes dangerous
Complication of constipation

On this page, we explain what fecal impaction is exactly, and the methods we have in front of us to go through what is called a “disimpaction”.

We also discuss the risks involved, and the need to work with your doctor to ensure it gets resolved in a timely manner.

A high-level list of complications have already been introduced at a high-level on a previous page. This is one of them.

Description

Fecal impaction (also spelled “faecal impaction”) is the development of a large, dry mass of stools in your colon. This mass becomes a plug, preventing further motion of stools toward the exit. Defecation is not possible anymore.

The colon is blocked and stools start to back up into the sigmoid colon. If left untreated, the whole lower bowel may be filled with unmovable fecal matters, a potentially life-threatening condition. Note that 70% of the impactions occur within the rectum, 20% within the sigmoid, and 10% further up into the colon(1).

See the pictures below, the first picture depicting a normal colon, and the second one showing an impacted colon with the plug located in the sigmoid region.

Normal, non-impacted colon

Impacted colon, plug in the sigmoid region

Causes of Fecal impaction

The causes of impaction are the same as the causes of constipation. The different constipation causes are addressed in a different section of this website.

The abuse of stimulant laxative is often mentioned as a risk factor(3). The long term use and dependence upon laxative to pass stools create a “lazy colon” situation. Accustomed to only function in the presence of those drugs, the colon loses the ability to do the work on its own. When the laxatives are stopped, impaction may ensue.

It is important to note that 3 demographic groups are particularly touched by fecal impaction:

  1. The elderly: A large proportion of people living in geriatric institutions suffer from fecal impaction(3). The lack of mobility of the elderly is usually a causative factor of chronic constipation, since overall body movement stimulate bowel movements. The degradation of muscles can also play a role, since muscles are involved during the defecation and pushing process.
  2. Children: A study published in the 1950’s already mentioned the fact that “this distressing condition is not rare, and it may easily go unrecognized”(4).
  3. Immobilized patients: spending most of their time in a chair or a bed due to an injury. The lack of exercise and motion, plus possible injuries to muscles and nerves piloting the colon muscles, may trigger serious constipation and impaction.

Fecal impaction in children can be particularly frustrating for both the child and the parents. The child is in pain, and is often unable to control leakage of feces. The child is ashamed, feels dirty, does not want to interact with other kids anymore, sometimes does not want to leave the house.

As parents, we may be unaware of the impaction, and believe that the child is willingly soiling his pants to assert his personality. We may grow frustrated with the additional cleaning chores.

For the sake of both child and parents, it is therefore important to not let chronic constipation linger, and take action early. If you observe some of the symptoms listed in the next section, bring it to the doctor’s attention.

Food for thoughts – impaction in children suffering from chronic constipation is a frequent occurrence. According to a study published in 2009 by the American Academy of Pediatrics, approximately 30% to 75% of children with long-standing functional constipation have fecal impaction(2).

Fecal impaction Symptoms

In addition to the common symptoms of constipation, the following symptoms may be observed:

  • A particularly bloated and hard abdomen;
  • Abdominal pain, often cramping, often near the site of obstruction;
  • The inability to defecate, despite the repeated urge to do so;
  • Thin or liquid stools. Some fecal matter manages to pass around the impacted feces, but can only do so in semi-liquid or liquid form. This should not be confused with diarrhea.
  • The involuntary soiling of clothes in a children who is already potty trained, also called “encopresis”;
  • The fecal plug may exert pressure on the bladder leading to loss of bladder control;
  • The pressure exerted by the fecal plug may create lower back pain;
  • Nausea and vomiting;
  • Longer term, weight loss and anorexia, fatigue and the sensation of a general malaise.

Fecal impaction treatments

Once fecal impaction has been diagnosed by your doctor, the following methods may be used to eliminate the problem.

1. Oral laxatives

Oral laxatives such as polyethylene glycol solutions may be used as a first line of action. They take 1 to 2 days to complete their stool softening action. This wait may be unacceptable if the risk of complications is high, or if there is sharp pain associated.

Moreover, even if the wait is acceptable, the laxatives may not be enough to remove large impactions. In which case an enema, or manual disimpaction may be performed to complete the removal operation.

2. Enemas

An enema may be used to soften up the plug and try to force an evacuation. The enema contains both water and stool softening agents. The injected water volume will exert pressure on the colon's walls and stimulate the peristalsis movement of the colon and triggers the defecation reflex.

When the administration of the liquid is completed, you will be asked to remain still for a few minutes, to let the solution mix with the stools and soften them up. Gentle massaging of the lower abdomen often aids in the mixing process.

3. Manual disimpaction

This method is attempted when the plug can be felt by the doctor through a rectal examination. In other words, the impaction is low enough in the rectum and accessible, making manual disimpaction a possibility.

This method may be used when the impaction needs to be removed immediately, due to the risk of complications or because there is severe pain that needs to be dealt with immediately. This method may also be performed in complement to either oral laxatives or enemas, when the former options have not been sufficient to remove a large plug.

The doctor will use lubricated gloves, and will try to break the impacted block into small bits that can be manually removed. Removing the whole impaction may take time, but bit by bit the area may be cleared of the plug. This intervention may be performed with the use of an anal retractor(3), which mechanically widens the anal opening to allow the doctor better access. It is rarely performed under general anesthesia, although intravenous sedation is often required.

Note that manual disimpaction is always undertaken by trained medical staff, as it can damage the mucous membrane of the colon or nerves located in that area if not done properly. Please do not attempt this procedure yourself.

Disimpaction in children

Dealing with children impaction is always stressful for both parents and the child. The child will need to be prepared in case he or she needs to go through an enema or manual disimpaction. Enemas do not have to be traumatic for the child. The 2009 American Academy of Pediatrics study mentioned above explains that enemas performed at home by the parents rather than a nurse in an unfamiliar place were well tolerated by the child(3).

Moreover, that same study concludes that:

  • Enemas and polyethylene glycol oral laxatives were equally effective in treating fecal impaction in children. Both methods have high success rate, removing impaction in 95% of the kids undertaking the study.
  • Oral laxatives (given in large doses) led to more episodes of faecal incontinence. Enemas led to more abdominal pain during the procedure.

This study should come as a reassurance to the parents. Oral laxatives and enemas are valid and effective approaches leading to disimpaction in most of the cases. Enemas, when explained and performed at home, are well accepted by the kids and do not need to be feared.

Conclusion

If you have been diagnosed with fecal impaction, a possible complication of chronic constipation, you have several options in front of you. We have presented those options on this page, hoping this knowledge will help you better navigate this painful and worrying situation.

The key is to take action immediately. If you observe some of the impaction symptoms, do not let the situation linger. Talk to your medical team, who will discuss the different treatment alternatives with you.

Once this situation is behind you, you will be able to focus on the next phase: prevention, making sure this does not happen again, and driving toward a constipation free life. We trust this website will help you to achieve this goal.


References for "Fecal Impaction"

(1) Mark B. Mengel; L. Peter Schwiebert (2005). "Family medicine: ambulatory care & prevention, Fourth Edition". McGraw-Hill Professional. ISBN 9780071423229.

(2) Bekkali NL, van den Berg MM, Dijkgraaf MG, van Wijk MP, Bongers ME, Liem O, Benninga MA. "Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG". Pediatrics. 2009 Dec;124(6):e1108-15. PubMed PMID: 19948614.

(3) Araghizadeh F. "Fecal impaction". Clin Colon Rectal Surg. 2005 May;18(2):116-9. PubMed PMID: 20011351.

(4) FEIGEN GM. "Chronic fecal impaction in children". Calif Med. 1957 Jan;86(1):41-3. PubMed PMID: 13383391.


Return from Fecal Impaction to the Complications of Constipation page

Return from Fecal Impaction to the Constipation-Remedies-For-All home

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