The term fecal impaction refers to a collection of hardened stools in the colon or rectum. This obstruction can make it difficult for a person to pass stools and may cause symptoms such as abdominal swelling, nausea, and rectal pain.

Without treatment, fecal impaction can cause serious and even life threatening complications.

This article outlines the symptoms and causes of fecal impaction and provides information on diagnosis, treatment, and prevention.

It also explains the potential complications of fecal impaction and the outlook for people with this condition. Finally, it answers some frequently asked questions about fecal impaction.

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A person with fecal impaction may be unable to have a bowel movement despite an intense need to do so.

Some people with fecal impaction may produce small, hard stools. Others may experience overflow diarrhea as looser stools work their way around the impaction. Overflow diarrhea can result in fecal incontinence.

Other common symptoms of fecal impaction include:

Fecal impaction can also cause more serious symptoms, such as:

Common causes of fecal impaction include:

Anyone can develop fecal impaction as a result of severe or untreated constipation. However, it is more common among older people and people who take certain medications long term, such as:

When diagnosing fecal impaction, a doctor will ask about a person’s symptoms and bowel habits.

A doctor will then perform a physical examination to check for signs of fecal impaction. This may include the following:

  • checking for abdominal distension or swelling
  • palpating (touching) the abdomen to check for a hard fecal mass within the colon
  • performing a digital rectal examination to check for a fecal mass within the rectum

According to a 2023 overview of research, if a digital rectal examination does not reveal signs of fecal impaction, doctors may request an abdominal X-ray or CT scan to check for impaction or other issues higher up in the colon.

There are four potential treatment options for fecal impaction. These are as follows.

Manual disimpaction

Doctors may use manual disimpaction to remove impacted stools.

Manual disimpaction involves lubricating the index finger and gently inserting it into the rectum to help remove the impacted stool. In some cases, doctors may use a suction device to help remove the stool.

Enema

A doctor may perform an enema if the impacted stools are higher up in the colon.

To perform the enema, a doctor will insert a catheter into the rectum and up into the colon and flush small amounts of water and stool softener into the area around the impaction.

The doctor may then gently massage the lower abdomen to help release the stool.

Some discomfort is typical during an enema, but a person should not feel any pain.

Oral laxatives

In some cases, doctors may administer an oral laxative, such as polyethylene glycol (MiraLAX).

Lower gastrointestinal and rectal surgery

In severe cases, a person may require lower gastrointestinal or rectal surgery to remove the fecal impaction. They may need anesthesia to relax the anal sphincter before the surgeon can remove the impacted stool.

The treatment time for fecal impaction varies according to the type of treatment a person receives.

  • Manual disimpaction: Where manual disimpaction is possible, this treatment method typically offers instant relief.
  • Enema: Enemas offer rapid relief, though the time it takes for an enema to work can vary.
  • Laxatives: Some laxatives may work faster than others. Polyethylene glycol may take 2–4 days to produce a bowel movement.
  • Surgery: In cases requiring surgery, removing the impacted stool should offer immediate relief. However, as with any surgical procedure, there is a risk of surgical complications. A person can discuss risks with their doctor before surgery.

The following may help to reduce the risk of fecal impactions:

  • drinking plenty of water
  • eating high fiber foods
  • taking a fiber supplement, such as psyllium, if approved by a doctor
  • reducing intake of sugary foods
  • exercising regularly
  • avoiding long periods of physical inactivity
  • avoiding long-term use of laxatives without a prescription
  • asking a doctor about the potential side effects of certain medications, such as:
    • pain relievers
    • diuretics
    • antidepressants

Fecal impaction is a serious condition that requires prompt medical treatment. Following an episode of fecal impaction, a person may need to make certain lifestyle changes to help manage constipation going forward.

According to a 2023 review, recurrent fecal impaction is very common among older adults and those in care.

Fecal impaction can cause the following complications:

A person should contact a doctor if they experience a change to their usual bowel habits or if they develop any other symptoms of fecal impaction.

Those with symptoms of fecal impaction should not take any laxatives unless a doctor advises them to do so. Laxatives that stimulate the bowel can cause severe abdominal cramps and may damage the bowels.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, constipation can refer to any of the following:

  • producing fewer than three bowel movements per week
  • producing stools that are hard, dry, or lumpy
  • producing stools that are painful or difficult to pass
  • feeling that the bowel has not emptied fully

Fecal impaction is a condition that can occur as a result of severe or untreated constipation.

Fecal impaction refers to a collection of hardened stools in the colon or rectum. It is typically a complication of severe or chronic constipation. Symptoms may include abdominal swelling, rectal pain, and overflow diarrhea.

There are various treatment options for fecal impaction, including manual disimpaction, enemas, and laxatives. In severe cases, a person may need surgery to remove the impacted stool.

Without treatment, fecal impaction can cause serious complications, such as bowel perforation. This, in turn, may lead to sepsis and even death. As such, anyone who experiences symptoms of fecal impaction should contact a doctor promptly for a diagnosis and appropriate treatment.