What to Know About Fecal Impaction

Fecal impaction is a potential complication of chronic constipation, which has various possible causes. These include dietary factors, insufficient fluid intake, medications, low activity level, and conditions affecting the colon, rectum, or anus. Fecal impaction is the formation of a large mass of hard stool in the rectum, which is typically too large to pass. Loose, watery stool may be able to get by, leading to diarrhea or the leakage of fecal material.

This article explains what causes fecal impaction and how to treat and prevent it.

Fecal impaction is a potential complication of chronic constipation. A person may experience constipation as a result of:

• a diet low in fiber
• limited fluid intake
• medication side effects
• a lack of physical activity
• a health condition affecting the colon, rectum, or anus

Constipation can perpetuate itself as painful bowel movements, which can lead to the avoidance of further bowel movements.

Learn more about what can cause constipation.

Various factors increase the risk of fecal impaction, although not everyone with risk factors will develop this complication. Risk factors for constipation and fecal impaction include:

• bowel movement avoidance
• brain or spinal cord injury
• constipation
• a diet low in fiber
• being in hospital for extended periods
• being an older adult
• irritable bowel syndrome
• limited fluid intake
• medications, such as antidiarrheals, narcotics, and anticholinergics, which doctors use to treat conditions such as peptic ulcer disease, diarrhea, nausea and vomiting, motion sickness, urinary incontinence, and Parkinson’s disease
• multiple sclerosis 
• pain in the anus or rectum, which can be due to inflammatory conditions, hemorrhoids, fissures, ulcers, or trauma
• previous instances of fecal impactions
• Parkinson’s disease
• physical inactivity

You may be able to lower your risk of constipation and fecal impaction by:

• drinking plenty of fluids
• eating foods high in fiber
• engaging in physical activity
• having bowel movements when the urge is present

If these approaches do not correct the issue, laxatives or enemas can help. However, it is important to use these treatments with caution, as overreliance can lead to a dependence on them.

Fecal impaction causes symptoms similar to those of constipation, but they can be more severe when the impacted stool presses on other tissues. Solid stool and other materials can back up in the colon, while liquid stools moving past the impaction can cause diarrhea or the uncontrolled leakage of stool.

Common symptoms of fecal impaction include:

• abdominal pain or cramping
• abdominal swelling, distension, or bloating
• back pain
• blood-streaked stools
• change in bowel habits
• diarrhea, which can be explosive
• difficulty urinating
• fecal incontinence, which is an inability to control bowel movements
• a feeling of incomplete emptying of the rectum
• small or thin, semi-formed stools

You should seek prompt medical care if you experience:

• sudden diarrhea or fecal leakage after constipation
• prolonged constipation for more than a few days
• the feeling of incomplete emptying of the rectum
• passing mucus with or without stool
• other symptoms that concern you

Prolonged fecal impaction can lead to an enlargement or obstruction of the colon, requiring emergency treatment. It is essential to seek immediate medical care for serious symptoms, such as:

• severe abdominal pain
• high fever
• vomiting blood
• rectal bleeding or bloody stool
• rigidity of the abdomen
• the inability to pass stool or gas
• a change in the level of consciousness or alertness, such as passing out or being unresponsiveness

Learn when to contact a doctor about constipation relief.

The initial treatment of fecal impaction focuses on relieving the impaction. Enemas can help soften the stool, which it may then be possible to break up manually into smaller pieces by gently massaging the lower abdomen. Suppositories may also help empty the rectum.

Once you have relief, you can turn your attention to preventing future impactions. Drinking more fluids, eating more fiber, and being more active can help prevent future problems. A doctor may also recommend medications, such as bulk fiber laxatives or stool softeners.

In children, promoting healthy and regular bowel habits can help prevent the development of fecal impaction.

Doctors rarely recommend surgery to relieve fecal impaction unless a complication develops, such as a severe bowel obstruction or colonic enlargement. Emergency surgery may be necessary if these complications develop.

Learn how doctors might treat constipation.

A doctor may advise you to take medications to prevent the recurrence of fecal impaction. The options include:

• bisacodyl suppositories (Bisa-Lax, Dulcolax, Fleet Bisacodyl)
• bulk fiber laxatives, such as psyllium (Fiberall, Metamucil)
• glycerin suppositories (Colace, Fleet)
• stool softeners, such as docusate (Colace, Diocto, DSS)

Without treatment, the complications of fecal impaction can be serious or even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan that you created with your doctor.

Possible complications of fecal impaction include:

• fecal or urinary incontinence
• bowel enlargement
• deterioration of bowel function
• severe bowel obstruction
• spread of infection

Below, we answer some common questions about fecal impaction.

You can still have bowel movements with impacted feces. In fact, a common sign of impacted feces and constipation is watery, runny stool. This is because this “overflow” stool will often pass around the impacted stool in the bowel, which can also lead to soiling.

One effective way to disimpact yourself is to take laxatives in sufficient amounts for a fixed period. This will loosen the stools and is called a disimpaction regimen.

Drinking plenty of water and exercising lightly can also help you pass bowel movements.

However, if you are concerned about the symptoms and duration of your constipation, it is best to speak with a doctor.

According to a 2022 paper, the ideal laxative for proximal fecal impaction is polyethylene glycol. Proximal fecal impaction means that the feces is impacted closer to the rectum. Distal fecal impaction, in which the stool is farther away from the rectum, may require enemas or suppositories.

Manual disimpaction from a trained healthcare professional can sometimes be uncomfortable, but most people find immediate relief as soon as it is complete.

Fecal impaction means that there are lumps of hard, dry stool in the bowels that a person may find difficult to pass. It results from prolonged constipation.

Some people find that over-the-counter laxatives and lifestyle modifications can help relieve constipation.

If constipation does not improve and fecal impaction occurs, enemas can help soften the stool, which doctors can then break up and remove manually. Suppositories may be useful between each step of the manual extraction to help empty the rectum.

Following the treatment of fecal impaction, it is important to take steps to reduce the risk of future constipation.