A fecal impaction is a large lump of dry, hard stool that stays stuck in the rectum. It is most often seen in people who are constipated for a long time.
Impaction of the bowels; Constipation - impaction; Neurogenic bowel - impaction
Constipation is when you are not passing stool as often or as easily as is normal for you. Your stool becomes hard and dry. This makes it difficult to pass.
Fecal impaction often occurs in people who have had constipation for a long time and have been using laxatives. The problem is even more likely when the laxatives are suddenly stopped. The muscles of the intestines forget how to move stool or feces on their own.
You are at more risk for chronic constipation and fecal impaction if:
Certain drugs slow the passage of stool through the bowels:
Common symptoms include:
Other possible symptoms include:
The health care provider will examine your stomach area and rectum. The rectal exam will show a hard mass of stool in the rectum.
You may need to have a colonoscopy if there has been a recent change in your bowel habits. This is done to check for colon or rectal cancer.
Treatment for the condition starts with removal of the impacted stool. After that, steps are taken to prevent future fecal impactions.
A warm mineral oil enema is often used to soften and lubricate the stool. However, enemas alone are not enough to remove a large, hardened impaction in most cases.
The mass may have to be broken up by hand. This is called manual removal:
Surgery is rarely needed to treat a fecal impaction. An overly widened colon (megacolon) or complete blockage of the bowel may require emergency removal of the impaction.
Most people who have had a fecal impaction will need a bowel retraining program. Your provider and a specially trained nurse or therapist will:
With treatment, the outcome is good.
Complications may include:
Tell your provider if you have chronic diarrhea or fecal incontinence after a long period of constipation. Also tell your provider if you have any of the following symptoms:
Iturrino JC, Lembo AJ. Constipation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 19.
Zainea GC. Management of fecal impaction. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 208.
Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.