Manhattan Gastroenterology
  • MIDTOWN 51 EAST 25TH, 4 FL New York, NY, 10010
  • UPPER EAST SIDE 983 PARK AVE, STE 1D New York, NY, 10028
  • UNION SQUARE 55 W. 17TH ST STE 102 New York, NY, 10011

Inability to pass stool regularly, hard, dry, and lumpy stools, abdominal pain or bloating, and disturbed gastrointestinal processes are signs of constipation. However, if you have the urge to pass stool but feel something blocked inside the intestines, or feel liquid stool leaking, it is a sign of fecal impaction. In this condition, the colon cannot remove the stool from the body using its normal contraction process, and the stool becomes hard and dry, disrupting the normal digestive route. Fecal impaction can turn severe and result in unpleasant outcomes and awkward moments if you do not take timely action. Visit Manhattan Gastroenterology to have your symptoms analyzed and get the best ways to avoid further complications. The top-rated specialists help you understand the causes behind fecal impaction and recommend lifestyle changes and treatment options to relieve your discomfort.

Fecal impaction can be unpleasant, though it turns serious only in rare cases. It is experienced by those who suffer from the most common gastrointestinal disorder, constipation, but other factors could also cause it. It can be treated by understanding the root cause and taking steps to prevent it in the first place.

Learning the Digestive Process

Fecal Impaction
Fecal Impaction

Understanding fecal impaction begins with knowing the digestive process. The process of digestion starts at the mouth when we eat. As we chew the food, it mixes with saliva and turns into a soft pulp, known as bolus, which is swallowed easily. The bolus is pushed down into the esophagus by the tongue, and it passes the epiglottis, a flap of tissue that covers the trachea to prevent choking.

As the chewed food makes its way down the esophagus and reaches the stomach, the digestive juices and a series of contractions of the stomach muscles help it break down further and digest. During this process, the bolus is broken down into a semi-liquid substance that enters the small intestine. Additional digestive juices from the small intestine, liver, and pancreas break it down into constituent parts that are absorbed by the small intestines and passed into the bloodstream.

The leftover is passed as a water product, primarily liquid, into the large intestine, also called the colon. The waste product includes undigested food, fluid, and discarded or damaged cellular material. When it passes through the colon, the majority of water is absorbed. It begins to take a solid form and becomes stool. When the digestive tract is functioning normally, the stool is entirely formed by the time it reaches the sigmoid colon, the final segment before it leaves the body, passing through the rectum.

What Is Fecal Impaction?

Fecal impaction, also known as impacted bowel, is a severe condition in which a hard, dry stool mass gets stuck in the colon or rectum. This stool will block the passage and cause a buildup of waste that becomes very difficult to pass.

Fecal impaction disturbs the normal gastrointestinal process in which digested food passes from the stomach to the intestines and into the colon and rectum. If it is left untreated, fecal impaction can cause severe complications. It becomes necessary to seek immediate medical attention if you notice symptoms of fecal impaction.

How Fecal Impaction Occurs?

When things do not go right in the digestive process and waste becomes stuck in the colon, it is known as fecal impaction of the colon. When you have an impacted colon, your stool becomes dry and won’t budge, making it impossible to excrete it from your body. Impacted feces blocks the way for new waste to leave the body, causing it to back up.

If you frequently suffer from irregular bowel movements and have to take laxatives to help you go regularly, you could end up with fecal impactions. In fecal impactions, a hardened and immobile bulk of stool remains stuck in the colon or rectum. The contractions of the colon that move the stool forward usually cannot dislodge the impacted mass, which may lead to serious trouble.

It is a relatively common condition, particularly among the elderly. It is prevalent among older people under care in a nursing home or a gastric ward of a hospital. It usually occurs in patients who suffer from constipation, a condition with strong connections to fecal impaction.

The most common symptoms of fecal impaction are:

  • Abdominal pain or discomfort, mainly after meals
  • Abdominal bloating
  • The ongoing urge to pass stool
  • Liquid stool or leakage of liquid stool
  • Headache
  • Nausea or feeling of malaise
  • Vomiting
  • Poor appetite or unexpected weight loss
  • Unexplained weight loss

Severe symptoms include:

  • Rapid heart rate
  • Dehydration
  • Hyperventilation, or rapid breathing
  • Fever
  • Confusion
  • Agitation or feeling of being irritated
  • Incontinence, or passing urine without trying

Some symptoms of fecal impaction resemble those of constipation, and you may often feel bloated and uncomfortably full. When the stool does not pass through the intestinal system and remains lodged in the colon, it becomes dry and hard. Your colon cannot remove it from the body using a normal contraction process which may begin to affect your normal body functions.

Causes of Fecal Impaction?

Fecal impaction is caused mainly by chronic constipation, a condition in which you have infrequent or difficult bowel movements. Constipation results from an underlying cause such as a lack of fibers like fruits and vegetables and less than regular water intake, which makes the stool forming in the colon dry and difficult to pass. Combined with decreased colon mobility, these factors can result in serious complications.

If the underlying cause is not investigated and treated, the stool can remain lodged in the colon or rectum. With time, it can also become so big and dense that it gets impossible to pass through the rectum, resulting in an uncomfortable situation.

As you continue to eat, the body continues to produce waste matter. It can lead to fecal loading, a condition in which a large volume of stool builds up in the rectum and adds to or worsens the fecal impaction.

Numerous conditions can either lead to fecal impaction or lead to its causes. Some possible causes of fecal impaction include:

  • Low fiber diet – Insoluble dietary fiber adds bulk to the stool that hastens its passage through the digestive tract. If you do not get sufficient fiber in your diet, it may result in constipation and fecal impaction in the long run.
  • Insufficient intake of water – Lack of water can leave the stool dry as it moves through the colon. The absorbent function of the colon absorbs the water from the stool as it passes, which can result in fecal impaction.
  • Use of too many laxatives – It is commonly believed that excessive use of laxatives can have the opposite effect. With time, the body can become so used to laxatives that unaided, regular bowel movements become difficult, and passing stool becomes challenging.
  • Opioids – In some cases, opioid pain relievers have the side effect of slowing down colon motility enough, which leads the colon to absorb too much water. Lack of water in the stool can make it hard and tough to pass.
  • Little or no physical activity – Exercise is essential for normal and healthy muscle contraction in the bowels. A sedentary lifestyle can lead to constipation and other medical conditions that result in fecal impaction.
  • Delayed bowel movement – Holding your stool for a long time, either due to unavailability of the bathroom or reduced sensation of the need to defecate that happens in old age, can lead to constipation and related problems.

Medical Conditions That May Cause Fecal Impaction

  • Irritable Bowel Syndrome (Ibs) – Constipation is one of the common symptoms of IBS, and if it is not controlled timely, it may turn severe and lead to fecal impaction.
  • Diabetes – The high blood sugar levels associated with diabetes can damage the blood vessels and nerves in the intestines. This damage can affect the usual passage of materials through the digestive tract or reduce the sensation or the need to visit the bathroom.
  • Hypothyroidism – The thyroid hormone regulates many body processes. Lower levels of thyroid can also slow down colon motility.
  • Neurological disorders – Neurological disorders can disrupt the signals sent from the brain to other parts of the body. They can affect the normal nerve impulse process that signals the movement in the colon and makes it difficult to pass stools regularly.

Fecal impaction does not go away quickly. It is essential to consult a trained and experienced healthcare provider who can determine the causes behind your fecal impaction and recommend the best treatment to take care of the medical condition causing the problem.

Treatment for Fecal Impaction

Regardless of the underlying causes behind the condition, fecal impaction is treated with the tried and tested methods that ease the pain and discomfort and help you pass stool easily. The doctor will determine the treatment method based on the severity of the condition and any other health concerns you may have.

Treatment options include:

  • Stool softeners – The doctor may suggest some oral medication for mild cases of impaction.
  • Enemas – Fluid consisting of water and salt is flushed into the rectum to loosen mild impaction and trigger the reaction to pass stool.
  • Suppositories – Laxatives are inserted into the rectum to soften the impacted mass and promote smooth passage.
  • Manual disimpaction – In extreme cases, the doctor will use digital manipulation to manually break up the stool mass while the remaining bulk is removed with an enema.

Once the hard mass obstructing the colon is gone, the bowel habits should return to normal. You can prevent fecal impaction in the future by making better lifestyle choices and following doctors’ orders regarding your diet and medications.

Complications Resulting from Fecal Impaction

If you are not careful and take timely action, you could end up with severe complications that can turn very painful and require invasive treatment.

Complications of fecal impaction of the colon include:

  • Tears in the colon wall
  • Hemorrhoids
  • Anal bleeding
  • Anal tears

Make an appointment to visit your doctor in case of any unusual pain or symptoms.

If you suffer from chronic constipation or your constipation does not seem to be improving, it is essential to address the issue before it turns serious. Fecal impaction can be treated successfully if it is diagnosed timely with a few lifestyle changes and over-the-counter medications. Do not let your irregular bowel movements disturb your home and work life. Call Manhattan Gastroenterology now to schedule an appointment with expert gastroenterologists to learn more about constipation treatment and how you can prevent fecal impaction. The top-rated specialists have all the answers and can help you understand your symptoms, focus on your bowel habits and make significant changes in your routine life to prevent complications. They provide the best guidance regarding your digestive, bowel, and colon health for lasting overall wellbeing.

Updated on Oct 16, 2022 by Dr. Shawn Khodadadian (Gastroenterologist) of Manhattan Gastroenterology