Fecal Impaction

Nicole A. Doria, MD, Anna L. Silverman, MD and Marie L. Borum, MD, EdD, MPH, MACP, FACG, AGAF Reviewed 06/2019

BASICS

DESCRIPTION

Incomplete evacuation of feces leading to the formation of a large, firm, immovable mass of stool in the rectum or distal sigmoid colon with resultant partial or complete obstruction...

DIAGNOSIS

HISTORY

Abdominal pain and bloating
Constipation
Rectal discomfort
Incomplete evacuation, use of digital maneuvers
Fecal incontinence, paradoxical (overflow) diarrhea
Nausea, vomiting, anorexia
Gen...

TREATMENT

GENERAL MEASURES

Treatment centers on removal of the impaction and prevention of recurrence.
Manual disimpaction and extraction of fecal mass is often required.
For stool located higher in the ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Maintain ≥3 bowel movements per week.

DIET

High fiber (20 to 25 g/day) with adequate hydration (minimum 2 L/day). Fermentable (soluble) fiber sou...

REFERENCES

Rao SS, Go JT. Update on the management of constipation in the elderly: new treatment options. Clin Interv Aging. 2010;5:163–171. [View Abstract on OvidMedline]

Higgins PD, Johanson ...

ADDITIONAL READING

Obokhare I. Fecal impaction: a cause for concern? Clin Colon Rectal Surg. 2012;25(1):53–58. [View Abstract on OvidMedline]
Rey E, Barcelo M, Jiménez Cebrián MJ, et al. A nation...

CODES

ICD10

K56.41 Fecal impaction
K59.00 Constipation, unspecified
R15.9 Full incontinence of feces

ICD9

560.32 Fecal impaction
564.00 Constipation, unspecified
787.60 Full incontinence of feces

SNOMED

446350...

CLINICAL PEARLS

Constipation and fecal impaction are common in elderly and hospitalized patients.
Opioids are a common cause of constipation and resultant impaction. Use a bowel hygiene regimen for pat...

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