Citation, DOI & article data
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.
Treatment and prognosis
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.
- 1. Hussain Z, Whitehead D, Lacy B. Fecal Impaction. Curr Gastroenterol Rep. 2014;16(9):404. doi:10.1007/s11894-014-0404-2 - Pubmed
- 2. Dewulf M, Blomme Y, Coucke C. Faecal Impaction Causing Bilateral Pelvic Venous Thrombosis. Acta Chir Belg. 2018;118(2):110-2. doi:10.1080/00015458.2017.1310482 - Pubmed
- 3. Obokhare I. Fecal Impaction: A Cause for Concern? Clin Colon Rectal Surg. 2012;25(1):53-8. doi:10.1055/s-0032-1301760 - Pubmed
- 4. Pleasant V, Sammarco A, Keeney-Bonthrone G, Bell S, Saad R, Berger M. Use of X-Ray to Assess Fecal Loading in Patients with Gastrointestinal Symptoms. Dig Dis Sci. 2019;64(12):3589-95. doi:10.1007/s10620-019-05770-9 - Pubmed
- 5. Khan O, Shankar P, Parikh A et al. Radiographic Stool Quantification: An Equivalence Study of 484 Symptomatic and Asymptomatic Subjects. Abdom Radiol (NY). 2019;44(3):821-7. doi:10.1007/s00261-018-1869-5 - Pubmed