Fecal Impaction

Abstract

Fecal impaction (FI) is a common and potentially serious medical condition that occurs in all age groups. Children, incapacitated patients, and the institutionalized elderly are considered the highest at-risk populations. FI usually occurs in the setting of chronic or severe constipation, anatomic anorectal abnormalities, and neurogenic or functional gastrointestinal disorders. Generally, FI is a preventable disorder, and early recognition is important, as it is associated with increased morbidity, mortality, and high health care costs. Evaluation with a careful history and physical examination, in conjunction with radiologic imaging, such as an acute abdominal series or computed tomography (CT), is imperative. Prompt identification and treatment minimize the risk of complications attributable to FI, which may include bowel obstruction leading to stercoral ulcer, perforation, peritonitis, or cardiopulmonary collapse with hemodynamic instability. Treatment options include manual fragmentation and extraction of the fecal mass, distal colonic cleansing using enemas and rectal lavage with the aid of a sigmoidoscope, and/or using water-soluble contrast media such as Gastrografin to both identify the extent of the impaction and aid in cleansing and removal. Surgical resection of the involved colon or rectum is reserved for peritonitis resulting from bowel perforation. Since recurrence is common, implementing preventive measures such as increasing daily water and fiber intake, limiting medications that decrease colonic motility, using secretagogues or prokinetic agents, and treating underlying anatomic defects are highly important.

Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult

“…Scientific evidence regarding which type should be used is scarce, but most commonly used enemas include lukewarm water, saline solution (fisioenema) or some sort of osmotic compound (143).…”

Constipation: an overlooked, unmanaged symptom of patients with pheochromocytoma and sympathetic paraganglioma

“…In addition, owing to chronic hypertension, fibrinoid necrosis of intramural arterioles may lead to a further reduction in vascular supply. In this setting, fecal material can be retained in the gastrointestinal tract, and progressive reabsorption of water can result in dry, hard stools that get attached to the mucosa, predisposing to pressure necrosis, stercoral colitis and ulceration, bleeding, and perforation (19). In addition, patients can have obstruction and develop megacolon after holding stool for long periods of time (20).…”

“…Abdominal series and CT scans are recommended for patients with grade 3 and 4 constipation to quantify the amount of stool and identify patients at risk for severe complications or death (e.g., patients with fat stranding, mucosal sloughing, mesenteric hyperemia, or extraluminal gas) (19,20).…”

Softening Hard Stool Using Magnetically Controlled Fe3O4 Nanoparticles

“…(1,2) Complications attributable to fecal impaction include stercoral ulceration, rectovaginal fistula, megacolon, and colonic perforation, which are associated with high morbidity and high mortality. (3) Traditional therapies include hard stool fragmentation or manual disimpaction, and hard stool softening using enemas followed by distal colon for evacuation.…”

“…(3) Traditional therapies include hard stool fragmentation or manual disimpaction, and hard stool softening using enemas followed by distal colon for evacuation. (1,2,4) The iatrogenic injury of the sphincter muscles leading to megarectum is occasionally found after manual disimpaction, and bowel necrosis, perforation, and death are occasionally encountered after cleansing using soap-sud enemas. (5,6) Surgery is reserved for peritonitis induced by bowel perforation.…”