Fecal impaction

Last revised by Dr Daniel J Bell on 25 Aug 2022

Fecal impaction is the inability to spontaneously evacuate solid feces. It is common in the elderly population. A severe form of fecal impaction is often referred to as a fecaloma

Fecal loading is a poorly defined term but generally refers to the volume of fecal material in the colon, it is often used synonymously with fecal impaction. A causative relationship between fecal loading and symptoms (e.g. constipation, bloating, diarrhea) has not been established 4,5

Fecal impaction is common and usually seen among the elderly, bedridden patients or incapacitated people 1,2.

  • chronic or severe constipation
  • sedentary lifestyle
  • low fiber diet
  • certain medication, e.g. opioids 1,2
  • history of fecal impaction 3

Patients may complain of constipation, rectal discomfort, abdominal pain, tenderness or distension 1-3.

Fecal impaction is most commonly a complication of chronic or severe constipation where inspissated hard feces accumulates in the distal gastrointestinal tract, most commonly the rectum 3. Other causes include anatomical causes (e.g. megarectum, anorectal stenosis, malignancy) or functional causes (e.g. pelvic floor dysfunction) 3

Fecal impaction may be seen as a speckled low-density soft tissue mass within a distended large bowel, most commonly the rectum 1,2

Untreated fecal loading may lead to an increase in large bowel pressure with possible bowel obstructionstercoral colitis and/or stercoral perforation 1,2.

Impacted fecal removal may be performed manually, with water irrigation, enema, laxatives or with rectal cleansing under sigmoidoscopy 1,2.

Physical activity, fiber-rich diet, sufficient fluid intake and prokinetic drugs are prescribed to stimulate transit and to change the stool consistency, thus preventing recurrence 1,2.

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Cases and figures

  • Case 1: complicated by large bowel obstruction
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  • Case 2: massive
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  • Case 3: massive
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  • Case 4: with stercoral colitis
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