7/17/15, 21:14Fecal impaction - Wikipedia, the free encyclopedia

Page 1 of 4https://en.wikipedia.org/wiki/Fecal_impaction

Fecal impaction

Plain abdominal X-ray showing a huge fecal impaction extending from thepelvis upwards to the left subphrenic space and from the left towards the right

flank, measuring over 40 cm in length and 33 cm in width.

Classification and external resources

Specialty Gastroenterology

ICD-9-CM 560.32 (http://www.icd9data.com/getICD9Code.ashx?icd9=560.32)

DiseasesDB 9450 (http://www.diseasesdatabase.com/ddb9450.htm)

MedlinePlus 000230(http://www.nlm.nih.gov/medlineplus/ency/article/000230.htm)

MeSH D005244 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?field=uid&term=D005244)

Fecal impactionFrom Wikipedia, the free encyclopedia

A fecal impaction is a solid, immobilebulk of human feces that can developin the rectum as a result of chronicconstipation. A related term is fecalloading which refers to a large volumeof stool in the rectum of anyconsistency.[1]

Contents1 Signs and symptoms2 Causes3 Prevention4 Treatment5 References6 Further reading

Signs and symptomsSymptoms include chronicconstipation. There can be fecalincontinence and paradoxical oroverflow diarrhea (encopresis) as liquidstool passes around the obstruction.Complications may include necrosisand ulcers of the rectal tissue.Abdominal pain and bloating couldalso be present depending on theseverity of the condition. Loss ofappetite can also occur.

CausesThere are many possible causes; for example, physical inactivity, not eating enough (particularly of fiber), andnot drinking enough water. Medications such as opioid pain relievers (suboxone, methadone, codeine,oxycodone, hydrocodone, etc.) and certain sedatives that reduce intestinal movement may cause fecal matter tobecome too large, hard and/or dry to expel. Specific diseases or conditions, such as irritable bowel syndrome,neurological disorders, diabetes, and autoimmune diseases such as amyloidosis, celiac disease, lupus, and

7/17/15, 21:14Fecal impaction - Wikipedia, the free encyclopedia

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scleroderma can cause constipation. Hypothyroidism can cause chronic constipation because of sluggish,slower, or weaker colon contractions. Iron supplements or increased blood calcium levels are also potentialcauses. Spinal cord injury is a common cause.

Manual removal of a fecal impaction is often required with obese patients in traction, after a barium enema, andin poorly hydrated older adults.

PreventionReducing opiate-based medication (when possible, tolerable, and safe; prescription medication changes shouldbe done under the supervision of a physician), an adequate intake of liquids (water) and dietary fiber and dailyexercise.

TreatmentThe treatment of fecal impaction requires both the remedy of the impaction and treatment to prevent futurerecurrences. Decreased motility of the colon results in dry, hard stools that in the case of fecal impactionbecome compacted into a large, hard mass of stool that cannot be expelled from the rectum.

Various methods of treatment attempt to remove the impaction by softening the stool, lubricating the stool, orbreaking it into pieces small enough for removal. Enemas and osmotic laxatives can be used to soften the stoolby increasing the water content until it is soft enough to be expelled. Osmotic laxatives such as magnesiumcitrate work within minutes - 8 hours for onset of action, and even then they may not be sufficient to expel thestool.

Osmotic laxatives can cause cramping and even severe pain as the patient's attempts to evacuate the contents ofthe rectum are blocked by the fecal mass. Polyethylene glycol (PEG 3500) may be used to increase the watercontent of the stool without cramping; however, since it may take 24 to 48 hours for it to take effect, it is notwell suited to cases where the impaction needs to be removed immediately due to risk of complications orsevere pain. Enemas (such as hyperosmotic saline) and suppositories (such as glycerine suppositories) work byincreasing water content and stimulating peristalsis to aid in expulsion, and both work much more quickly thanoral laxatives.

Because enemas work in 2–15 minutes, they do not allow sufficient time for a large fecal mass to soften. Even ifthe enema is successful at dislodging the impacted stool, the impacted stool may remain too large to be expelledthrough the anal canal. Mineral oil enemas can assist by lubricating the stool for easier passage. In cases whereenemas fail to remove the impaction, polyethylene glycol can be used to attempt to soften the mass over 24–48hours, or if immediate removal of the mass is needed, manual disimpaction may be used. Manual disimpactionmay be performed by lubricating the anus and using one gloved finger with a scoop-like motion to break up thefecal mass. Most often manual disimpaction is performed without general anaesthesia, although sedation maybe used. In more involved procedures, general anaesthesia may be used, although the use of general anaesthesiaincreases the risk of damage to the anal sphincter. If all other treatments fail, surgery may be necessary.

Individuals who have had one fecal impaction are at high risk of future impactions. Therefore, preventativetreatment should be instituted in patients following the removal of the mass. Increasing dietary fiber, increasingfluid intake, exercising daily, and attempting regularly to defecate every morning after eating should be

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promoted in all patients.

Often underlying medical conditions cause fecal impactions; these conditions should be treated to reduce therisk of future impactions. Many types of medications (most notably opioid pain medications, such as codeine)reduce motility of the colon, increasing the likelihood of fecal impactions. If possible, alternate medicationsshould be prescribed that avoid the side effect of constipation.

Given that all opioids can cause constipation, it is recommended that any patient placed on opioid painmedications should be given medications to prevent constipation before it occurs. Daily medications can also beused to promote normal motility of the colon and soften stools. Daily use of laxatives should be avoided bymost individuals as it can cause the loss of normal colon motility. However, for patients with chroniccomplications, daily medication under the direction of a physician may be needed.

Polyethylene glycol 3350 can be taken daily to soften the stools without the significant risk of adverse effectsthat are common with other laxatives. In particular, stimulant laxatives should not be used frequently becausethey can cause dependence in which an individual loses normal colon function and is unable to defecate withouttaking a laxative.[2] Frequent use of osmotic laxatives should be avoided as well as they can cause electrolyteimbalances.

References1. (UK), National Collaborating Centre for Acute Care (2007). Faecal incontinence the management of faecal incontinence

in adults. London: National Collaborating Centre for Acute Care (UK). ISBN 0-9549760-4-5.2. Joo JS, Ehrenpreis ED, Gonzalez L et al. (June 1998). "Alterations in colonic anatomy induced by chronic stimulant

laxatives: the cathartic colon revisited" (http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0192-0790&volume=26&issue=4&spage=283). Journal of ClinicalGastroenterology 26 (4): 283–6. doi:10.1097/00004836-199806000-00014 (https://dx.doi.org/10.1097%2F00004836-199806000-00014). PMID 9649012 (https://www.ncbi.nlm.nih.gov/pubmed/9649012).

Further readingWrenn K (September 1989). "Fecal impaction". The New England Journal of Medicine 321 (10): 658–62.doi:10.1056/NEJM198909073211007 (https://dx.doi.org/10.1056%2FNEJM198909073211007).PMID 2671728 (https://www.ncbi.nlm.nih.gov/pubmed/2671728).Dugdale, David C. (January 31, 2011). "Fecal impaction"(http://www.nlm.nih.gov/medlineplus/ency/article/000230.htm). A.D.A.M., Inc.Gattuso JM, Kamm MA, Halligan SM, Bartram CI (April 1996). "The anal sphincter in idiopathicmegarectum: effects of manual disimpaction under general anesthetic". Diseases of the Colon and Rectum39 (4): 435–9. doi:10.1007/bf02054060 (https://dx.doi.org/10.1007%2Fbf02054060). PMID 8878505(https://www.ncbi.nlm.nih.gov/pubmed/8878505).

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Categories: Gastroenterology Feces

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