fecal impactation
Jump to navigation
Jump to search
Introduction
A large, firm* immobile mass of stool in the rectum or colon due to incomplete evacuation of feces.
* apparently there is an entity soft fecal impactation
Etiology
- pathophysiology
- increased colonic transit time
- constipation
- decline in pelvic muscular strength
- decline in force of peristalsis
- increased rectal tone
- risk factors
- institutionalized elderly
- depression
- hypothyroidism
- neurologic disorders
- painful rectal conditions
- lack of fiber
- dehydration
- hypokalemia
- hypercalcemia
- pharmacologic agents
- stimulant laxatives: Dulcolax, Senna
- opiates
- iron
- aluminum-containing antacids
- psychoactive substances
- anticholinergic agents
- infants with congenital bowel dysfunction
Clinical manifestations
- abdominal pain, frequently postprandial
- abdominal distention
- fecal incontinence:
- may be mistaken for & treated as diarrhea
- stool in fault (including soft stool)*
- nausea/vomiting
- anorexia
- tenesmus
- headache
- confusion
- urinary frequency & incontinence
- rectal or abdominal mass
- fever
- tachycardia
- tachypnea
- hypertension
- signs of dehydration
* allegedly, there is an entity soft fecal impactation (see contipation)
Laboratory
- stool guaiac
- serum chemistries
- WBC count may be elevated
Diagnostic procedures
- sigmoidoscopy if indicated
Radiology
- plain abdominal radiograph
- barium enema is indicated
Complications
- urinary tract infections
- bowel obstruction
- intestinal perforation
- rectal bleeding
- stercoral ulcers
- volvulus
- rectovaginal fistulas in elderly women
- dystocia in pregnant women
Differential diagnosis
Management
- treatment of impacted patient
- manual disimpactation
- enemas or Harris flush
- flexible sigmoidoscopy & fragmentation of feces with water jet
- bisacodyl suppository after disimpactation
- alternative treatment: osmotic fluids orally
- prophylaxis