Fecal Impaction - An Impacted Bowel

Introduction:

Fecal impaction is the hardened, dry stool that is left behind in the rectum or colon, often seen in people who have been constipated for a long time. It is a common condition in the elderly who have bowel issues. It can be a serious concern, even leading to death if not treated properly. It is common among older adults.

What Is the Difference Between Constipation and Fecal Impaction?

When it is difficult to pass stool, the condition is called constipation. When constipation is left untreated, it can cause stool accumulation in the colon or rectum. This condition is called fecal impaction.

What Are the Causes of Fecal Impaction?

Fecal impaction is common in the elderly. The main causes of this condition can be;

• Constipation: It is a condition where the stool gets hardened and is difficult to pass. As a result, it gets stored in the colon or rectum. It can cause many difficulties like abdominal pain, bloating, a feeling of fullness, etc. Constipation can be a result of some medicine intake, dehydration, lack of fiber in food, problems with the digestive system, etc.

• Overuse of Laxatives: Using laxatives very frequently prevents the body from knowing when to have a bowel movement. The body might not be able to respond to the urge, resulting in stool buildup in the colon.

• Medications: Certain medicines like opioids can slow down the digestive system, causing stool to build up in the colon.

• Sedentary Lifestyle: Lack of activities can also cause fecal impaction.

• Bathroom Habits: If defecation does not happen when the body urges (due to the lack of facility, or inability to pass stool in a new place, etc.), it can make the body to stop sending the signal, leading to accumulation of stool in the colon.

• Jet Lag: Due to the shift in the timings, the body might find it difficult to adapt to the new timings and surroundings.

• Neurogenic Bowel: A disease of the brain or the nervous system that damages the nerves that go to the muscles of the intestine.

• Anorectal Surgery: Surgeries related to the anus and rectum can cause fecal impaction, though very rarely.

Who Are at a Higher Risk of Fecal Impaction?

Fecal impaction can occur in all ages, but is more common in;

• Elderly.

• Children.

• Those who have mobility problems.

• People with neuropsychiatric issues like Alzheimer’s disease, parkinsonism, etc.

How Common Is Fecal Impaction?

The condition is common among the elderly. Nearly half of the people in old age experience fecal impaction. This can be because of decreased physical activity, certain medications, and due to some neurological issues. It can be common in people admitted to the hospital after a major surgery or any other major health issues, due to decreased physical activity and the medications used. It is less common among the younger generation who are physically active and have a regular life.

What Are the Symptoms of Fecal Impaction?

All symptoms of fecal impaction can cause other health issues and hence, require medical attention. The common symptoms include;

• Leakage of liquid stool.

• Abdominal discomfort.

• Bloating.

• Abdominal pain.

• Nausea.

• Headache.

• Vomiting.

• Unexplained weight loss.

• Loss of appetite.

• Swollen belly.

• No urge to urinate.

More severe symptoms can include;

• Tachycardia (a fast heartbeat).

• Fever.

• Confusion.

• Hyperventilation or rapid breathing.

• Incontinence or stool passing without an urge.

• Dehydration.

How Is Fecal Impaction Diagnosed?

• A proper case history is essential to obtain details about the duration of the condition, lifestyle, food habits, any medications used, etc. A physical examination can include pressing down on the stomach to feel for the mass. The doctor may insert a finger in the rectum (digital rectal examination) to feel for any other problems that may cause the condition.

• X-ray of the abdomen might be advised to locate the mass impaction.

• Sigmoidoscopy: A sigmoidoscope is a thin tube with a light and a camera. It might be inserted to inspect the colon to check for fecal impaction or other conditions that might cause fecal impaction.

• Abdominal ultrasound also can be advised.

How Is Fecal Impaction Treated?

The obstruction caused by fecal impaction can be removed by;

• Disimpaction: Removing the stool.
• Colon Evacuation: Fluids are used to remove waste from the colon.
• Bowel Regimen: Advice is given to follow proper bowel movements.

Many methods are available for disimpaction, depending upon the severity and location of the impaction. Some of the methods include;

• Enema: In this procedure, fluid is injected into the rectum to loosen the impacted stool.

• Physically-Assisted Removal: A medical assistant might help to dislodge the impacted material using their gloved finger. This is called digital disimpaction. They might also perform abdominal massage to target the hardened stool.

• Laxative: A laxative can be used to soften the stool, enabling its easy passage.

• Surgery: This is done in case of severe fecal impaction, especially in case of bleeding due to a tear in the rectum.

Abdominal discomfort and pain will disappear as soon as the disimpaction is done. Further instructions to prevent fecal impaction will be given.

Complications of Fecal Impaction

Untreated fecal impaction can cause severe complications, which can be life-threatening.

Various complications can include:

• Bowel perforation (a hole in the colon).
• Hemorrhage or bleeding.
• Uncontrolled bowel movements (fecal incontinence).
• Ulcer.

How Can Fecal Impaction Be Prevented?

Fecal impaction can be prevented by modification of lifestyle and food habits.

• Increasing the fiber content in the diet.

• Drinking adequate amounts of fluid and staying hydrated.

• Doing proper exercise and staying active.

• Avoiding unnecessary use of medicines like laxatives.

Conclusion:

Fecal impaction is a common yet critical condition marked by the presence of leftover hardened and dry stool in the rectum or colon, frequently seen in cases of long-term constipation. It can even be fatal, if not treated properly. It is prevalent among older adults with bowel issues. Proper diagnosis and timely treatment of the condition are required. Untreated fecal impaction can result in severe and life-threatening complications.