Management of Fecal Impaction

CHAPTER 102 Management of Fecal Impaction



George G. Zainea


Fecal impaction is a common condition that typically occurs in the bedridden or nursing home patient. Individuals who suffered a cerebrovascular accident are at particular risk. Fecal impaction is the most common gastrointestinal disorder occurring in patients with a spinal cord injury. Medications such as narcotics predispose to this problem. It is also a common complication of anorectal procedures as a result of reflex spasm of the anal sphincter. Painful anal fissures may cause the same problem.



Diagnosis


Fecal impaction should be suspected when a patient has unexplained constipation or diarrhea. Diarrhea occurs as liquid stool passes around the hard fecal bolus. Rectal distention from the fecaloma causes reflex relaxation of the internal anal sphincter. The patient may have acute or chronic large bowel obstruction, both clinically and by radiographic examination. The chronic obstruction will increase mucosal water and electrolyte secretion, leading to frequent, loose, watery stools that pass around the bolus. The patient with spinal cord injury may demonstrate autonomic hyperreflexia with pain, fever, tachycardia, and abdominal distention.


Digital rectal examination reveals impacted feces palpated in the rectum. It is important to assess for size and consistency of the bolus as well as for the presence of blood. In the normal situation, the rectal ampulla remains empty. A fecal bolus does not pass beyond the rectosigmoid junction until the act of defecation commences.


Complications of fecal impaction can include acute or chronic bowel obstruction, mucosal ulceration, and hemorrhage.


After disimpaction, particularly in the recurrent setting, it is important to rule out an anatomic cause of obstruction. This may require proctosigmoidoscopy or a water-soluble contrast examination. Impaction may be associated with an anal or rectal stricture. The practitioner must assess for the presence of a tumor. Last, a deep mucosal ulcer may cause bleeding or infection as a result of fecal impaction. This is known as a stercoral ulceration.

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May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Management of Fecal Impaction

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