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fecal impactation
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:
- risk factors
a) institutionalized elderly
b) depression
c) hypothyroidism
d) neurologic disorders
e) painful rectal conditions
- anal fissures
- hemorrhoids
f) lack of fiber
g) dehydration
h) hypokalemia
i) hypercalcemia
j) pharmacologic agents
- stimulant laxatives: Dulcolax, Senna
- opiates
- iron
- aluminum-containing antacids
- psychoactive substances
- anticholinergic agents
k) infants with congenital bowel dysfunction
- stenosis
- atresia
- Hirschsprung's disease
Pathology:
- increased colonic transit time
- constipation
- decline in pelvic muscular strength
- decline in force of peristalsis
- increased rectal tone
Clinical manifestations:
1) abdominal pain, frequently postprandial
2) abdominal distension
3) fecal incontinence:
- may be mistaken for & treated as diarrhea
- liquid stool may be overflow constipation
4) stool in fault (including soft stool)*
5) nausea/vomiting
6) anorexia
7) tenesmus
8) headache
9) confusion
10) urinary frequency & incontinence
11) rectal or abdominal mass
12) fever
13) tachycardia
14) tachypnea
15) hypertension
16) signs of dehydration
* allegedly, there is an entity soft fecal impactation (see constipation)
Laboratory:
1) stool guaiac
2) serum chemistries
a) serum Na+: hyponatremia
b) serum K+: hypokalemia
c) serum creatinine, serum urea nitrogen
- BUN/creatinine ratio > 20
3) WBC count may be elevated
Special laboratory:
-> sigmoidoscopy if indicated
Radiology:
1) plain abdominal radiograph
2) barium enema if indicated
Differential diagnosis:
1) irritable bowel syndrome
2) colorectal carcinoma
3) inflammatory bowel disease
4) diverticulitis
Complications:
1) urinary tract infections
2) bowel obstruction
3) intestinal perforation
4) rectal bleeding
5) stercoral ulcers
6) volvulus
7) rectovaginal fistulas in elderly women
8) dystocia in pregnant women
Management:
1) treatment of impacted patient
a) manual disimpactation
b) enemas or Harris flush
c) flexible sigmoidoscopy & fragmentation of feces with water jet
d) bisacodyl suppository after disimpactation
e) alternative treatment: osmotic fluids orally
- GoLYTELY
- Colyte
2) prophylaxis
a) high fiber diet
b) adequate hydration
a) > 1.5 liters/day
b) increase fluids in summer months
c) regular activity
d) regular bowel habits
e) avoid hot water or soap enemas
Related
fecal incontinence; anal incontinence; bowel incontinence; includes: encopresis
feces (stool)
General
constipation; dyschezia
intestinal obstruction
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 359-360
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998