What Is Fecal Impaction? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Unless you happen to be a toddler, you probably don't want to talk about feces — that substance more colloquially known as poop. But when things go wrong in that department, it pays to understand what is happening — and what to do to prevent and treat problems. One such problem is fecal impaction, which occurs when a hard, dry plug of stool becomes stuck in the rectum and cannot be passed.

People with severe, long-term constipation — a problem that affects approximately 20 percent of adults — may eventually go on to develop a fecal impaction, according to an article published in Clinical Interventions in Aging. (1) It isn’t pretty, but what essentially happens is that a mass of dried-out stool gets stuck and can end up blocking the colon instead of exiting your system smoothly and comfortably.

Generally, if you’re suffering from fecal impaction, you’ll know it. The symptoms can be so severe that you may require emergency treatment, according to Harvard Health. (2) Symptoms include: (2,3)

• Watery stool
• Abdominal pain, especially after eating
• An ongoing urge to have a bowel movement
• Headache
• Bloating
• Nausea and vomiting
• Loss of appetite
• Weight loss
• Feeling under the weather
• Straining to pass stool
• Passing small, hard "marbles" of stool
• Bleeding from the rectum
• Stool leakage
• A feeling of pressure on the bladder
• Loss of bladder control
• Low back pain

RELATED: Soluble vs. Insoluble Fiber: How to Know What’s Right for You if You Have IBS

Chronic and severe constipation can lead to fecal impaction. The problem often occurs in children, and, especially, in people who live in nursing homes. According to an article in Clinics in Colon and Rectal Surgery, the risk of fecal impaction is highest in the elderly; one study cited found that 42 percent of patients in a geriatric ward had the condition. (4) It is also common in patients with Alzheimer’s disease, Parkinson’s disease, dementia, and severe stroke, as well as in those with spinal cord injuries. (4)

Children may develop a fecal impaction when they withhold stool during toilet training, fear passing stool because of previous pain or discomfort, avoid using the bathroom because they don't want to interrupt their play, or don't drink enough fluids or eat enough fiber. (You may hear your doctor refer to the condition as encopresis.)

Other factors that can contribute to the condition include poor diet, and not paying attention to the need to use the bathroom because of depression or other illnesses, per past research. (5)

There are other potential causes. They include: (3,4)

• Skimping on drinking fluids
• A diet that’s low in fiber
• Pelvic floor dysfunction
• A history of chronic constipation
• Dependence on laxatives to have a bowel movement
• Medications that reduce intestinal movement, such as narcotic pain medications, iron supplements, calcium supplements, or calcium channel blockers
• A disorder of the large intestine and rectum, such as Hirschsprung's disease or Chagas disease
• A thyroid condition or another metabolic disorder, such as diabetes or uremia

If you suspect you have fecal impaction, see your doctor. He or she will ask you questions about how you’ve been feeling, examine your abdomen, and perform a digital rectal exam with a gloved finger to check for a mass of impacted stool. In addition, you may also need blood work, or procedures such as a CT scan. Your doctor may suggest a colonoscopy after the fecal impaction has gone away, to make sure that this change in bowel movements isn’t a sign of colon cancer.

As long as fecal impaction is diagnosed and treated quickly, it generally won’t lead to complications. And most people will go on to have normal bowel habits. One issue, though, is that fecal impaction can recur if constipation continues. A study cited often in the literature found that 39 percent of people with fecal impaction had experienced it before. (6) If constipation is a chronic issue, try to work with your healthcare provider or a specialist to address it.

Once treated, fecal impaction goes away quickly. Since it can recur, however, particularly in elderly or sedentary people, besides suggesting diet and lifestyle changes, your doctor may prescribe treatment with stool softeners, laxatives, or periodic enemas.

In some cases, a fecal impaction will have to be cleared by a healthcare professional. They will use a gloved finger to sweep all the stool that can be reached out of the rectum. This is known as manual disimpaction.

Another technique, known as distal washout, involves softening the stool with an enema or rectal suppository so it can be eliminated. Or your doctor might prescribe an oral solution of polyethylene glycol or an oral laxative made of magnesium citrate.

You might receive one of these three treatments or some combination of them. In rare cases, your doctor may use a sigmoidoscope to wash out the bowel with water and clear the impaction. (2,7)

Those experiencing pelvic floor dysfunction may benefit from physical therapy.

Medication Options

The following medications may be used to treat fecal impaction:

• Enemas
• Suppositories
• Oral laxatives

Alternative and Complementary Therapies

Fecal impaction can’t be solved by alternative or complementary therapies, but a study published in Evidenced-Based Complementary and Alternative Medicine found that acupuncture and some herbal treatments, including the fiber supplement psyllium, eased chronic constipation, which, when left untreated, can lead to fecal impaction. (8)

RELATED: Does Medicare Cover Acupuncture?

Prevention of Fecal Impaction

After a fecal impaction has been treated and the rectum has been cleared of stool, it’s important to carefully follow a bowel retraining program to prevent another episode.

You'll probably be instructed to:

• Drink plenty of water.
• Eat sufficient amounts of fiber. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), adults should get 22 to 34 grams of fiber a day. (9) The exact amount depends on your sex and age.
• Use the bathroom regularly; when you feel the urge to defecate, don’t delay.
• Get regular exercise.
• Try bowel training, which involves conditioning yourself to pass stool at around the same time each day to avoid developing severe constipation again.
• Try Kegel exercises, which may help strengthen pelvic and rectal muscles.
• See a physical therapist if you’re experiencing pelvic floor dysfunction.

Occasionally using over-the-counter stool softeners or fiber supplements can help as well. But be aware that using laxatives too often can compound the problem, making it more difficult to pass stool.

If you suspect you have fecal impaction, it’s crucial to seek treatment, since the condition can lead to complications that could require hospitalization and even emergency surgery. These complications may include: (4,7)

• An ulcer of the colon
• Bowel obstruction, meaning you can’t have a bowel movement or even pass gas
• Perforation (a rupture that develops in your intestinal tract)
• Peritonitis (an inflammation of the abdominal lining)

• Fecal impaction is most common among seniors, particularly women, who are hospitalized or who live in nursing homes.
• Nearly 50 percent of nursing home residents experience chronic constipation, which leads to fecal impaction, notes a study published in the journal PLoS One. (10)
• Of those with fecal impaction, the study above found that 18.5 percent had experienced a single episode in the preceding year, 25.2 percent experienced more than one episode but less than one per month, and 3.6 percent experienced at least one episode a month. (10)
• Those with neurological disorders (such as dementia or stroke) are also at a higher risk.

There are few studies on race and the prevalence of fecal impaction. But chronic constipation is the most common risk factor for fecal impaction, and a widely cited study of data from a survey of more than 15,000 people found that constipation was more frequent in Black Americans than in white Americans — 17.3 percent of Black Americans reported constipation compared with 12.2 percent of white Americans. (11)

RELATED: Race-Adjusted Medicine May Deprive Black Patients of Treatment

The biggest risk factor for fecal impaction is chronic, untreated constipation.

Fecal impaction may also be a side effect of certain types of cancer or cancer treatments, or pain medications. (7,12) Fecal impaction can also cause urinary incontinence or fecal incontinence.

Fecal impaction may not be easy to talk about, but there are a number of good resources available with information about the condition, as well as its most common cause — constipation. Here are a few that are packed with trustworthy details:

• The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offers a wealth of information on constipation and other digestive disorders, as does the American College of Gastroenterology.

These medical center websites, among others, also offer information on fecal impaction:

• Harvard Health
• Mount Sinai