Is Impacted Stool an Emergency?

Impacted stool caused by chronic constipation can cause emergency complications, but treatment for mild cases is straightforward.

Fecal impaction is a gastrointestinal problem in which the stool becomes a dry, hard mass in the rectum or colon, and cannot be expelled naturally. The hardened stool obstructs the colon and additional fecal matter backs up in the colon causing considerable discomfort.

Fecal impaction usually occurs in people who are often constipated and is more common in seniors. The hardened feces must be removed promptly because it can cause serious complications. The underlying cause also must be treated to prevent recurrence.

The causes of fecal impaction include the following:

• Chronic constipation due to:
  • Metabolic disorders such as diabetes or hypothyroidism
  • Dietary habits such as insufficient fluid and fiber intake
  • Some medications such as opiates or calcium channel blockers
  • Spinal cord injury or nerve-related disorders such as Parkinson disease
• Structural or functional abnormalities from conditions such as:
  • Megarectum from diseases such as Chagas disease or Hirschsprung disease
  • Narrowing (stenosis) of the colon, rectum or anus 
  • Obstruction in the colorectal passage due to tumors or bowel diseases
  • Inflammatory bowel diseases such as Crohn’s
  • Pelvic floor dysfunction
• Anorectal surgery (rarely)
• Overuse of laxatives, which can lead to dependency on them, disrupting normal bowel function
• Being sedentary
• Habitually controlling the urge for bowel movement because of lack of access to a toilet or other reasons

Usually, fecal impaction develops after persistent constipation. Signs of constipation include:

• Fewer than three bowel movements in a week
• Small hard stools
• The need to strain hard or use laxatives to have a bowel movement
• Feeling of incomplete evacuation after a bowel movement

The symptoms of fecal impaction include:

• Watery diarrhea that leaks around the impacted mass
• Liquid stool that leaks out involuntarily (fecal incontinence) when coughing or laughing
• Nausea or vomiting
• Abdominal bloating and pain
• Lower back pain
• Urinary incontinence or frequency

If untreated, fecal impaction can lead to more severe symptoms such as:

• Dehydration
• Poor appetite and weight loss
• Rapid heart rate
• Rapid breathing
• Bleeding from the rectum
• Rectal prolapse
• Confusion and agitation
• Fever

Impacted stool can turn into an emergency if symptoms become severe in the absence of timely treatment. The hard fecal mass can exert pressure on the colon walls and cause tissue death (necrosis), ulceration or perforation. Colon perforation can cause leakage of stool into the abdominal cavity, leading to infection, sepsis and death.

Treatment for fecal impaction involves removal of the impacted stool as well as prevention of its recurrence. After the removal of the impacted stool, the patient may be required to undergo tests to establish the cause of fecal impaction and receive appropriate treatment.

Treatment procedures for removal of fecal impaction include the following:

• Distal softening or washout: Distal softening is to soften the stool from the rectal end, with the use of suppositories or enema. The softened stool is then passed out naturally. A commonly used enema solution is a mixture of water and docusate sodium, which helps the water penetrate the hard stool and soften it. 
• Proximal softening or washout: Proximal washout is to soften the stool by oral ingestion of solutions. Oral solutions are not used if the bowel is completely obstructed. Commonly used oral solutions include polyethylene glycol solution with electrolytes (GoLytely, NuLytely) and magnesium citrate diluted in clear liquids.
• Manual disimpaction: The hardened stool in the rectum is gently fragmented and manually removed by inserting a lubricated, gloved finger into the rectum.

In most cases, fecal impaction can be prevented by taking care not to get constipated. Constipation can generally be prevented by following lifestyle habits which include the following:

• Eat adequate high-fiber foods such as whole grains, vegetables and fruits.
• Drink plenty of water.
• Exercise regularly and stay active.
• Do not postpone or control bowel movements when the urge arises.
• Check with your doctor and take laxatives to relieve constipation and stool softeners or fiber supplements such as psyllium or methylcellulose to bulk up the stool.