Fecal Impaction Vs. Constipation: Symptoms, Causes, Treatment

Constipation is difficulty emptying your bowels. Fecal impaction is the buildup of hardened stool in your bowel that you can’t pass.

Fecal impaction is a potential complication of chronic constipation and less commonly occurs due to problems with the muscles inside your intestines.

Fecal impaction and constipation are both common among older adults, especially adults in nursing homes. Eating plenty of fiber and exercising regularly can help you prevent both conditions.

Let’s take a deeper look at the difference between fecal impaction and constipation.

Fecal impaction vs. constipation symptoms

Here’s a look at the symptoms of fecal impaction and constipation.

Constipation symptoms

Constipation can cause:

• fewer than three stools per week
• hard, lumpy, and dry stools
• stools that are difficult to pass or cause pain
• the feeling that you haven’t passed stool at all

Fecal impaction symptoms

People with fecal impaction often experience:

• constipation
• inability to evacuate their bowel
• swollen abdomen
• abdominal pain
• the ability to feel stool through your abdomen (in some thinner individuals)
• overflow diarrhea occasionally, where new stool leaks around the impaction

Fecal impaction vs. constipation causes and risk factors

Here’s a look at the causes and risk factors of constipation and fecal impaction.

Constipation causes and risk factors

Constipation affects about 16 out of 100 adults in the United States and 33 out of 100 people older than 60 years of age. Severe constipation affects about 70% of adults older than 65 years of age in nursing homes.

Constipation has many contributing causes, such as:

• inadequate fiber intake
• dehydration
• drinking too much caffeine or alcohol
• low levels of exercise
• structural problems with your bowel, such as tumors, a blockage, or narrowing
• muscular conditions like muscular dystrophy
• neurological conditions like:
  • stroke
  • Parkinson’s disease
  • multiple sclerosis
• some medications, such as:
  • anticholinergics
  • narcotics
  • antidepressants
  • calcium channel blockers
• celiac disease
• food allergy
• inflammatory bowel disease
• other conditions, such as:
  • hypothyroidism
  • diabetes
  • hypercalcemia

Fecal impaction causes and risk factors

Fecal impaction is primarily caused by constipation. Occasionally, it’s caused by a medical condition that slows the contraction of the muscles in your bowel or from having a barium enema performed.

Fecal impaction is common among older adults, especially those in nursing homes or who take nonsteroidal anti-inflammatory drugs (NSAIDs).

When to contact a doctor

Consider seeing a doctor or other healthcare professional if you:

• don’t have improvements in your constipation with treatment
• are regularly constipated or bloated
• have blood in your stool
• have lost weight without trying
• are constipated and feel chronically tired
• are taking pain relievers that cause constipation
• have sudden changes to your bowel habits
• have abdominal pain

Diagnosing fecal impaction and constipation

A doctor can diagnose constipation by:

• asking you questions about your bowel habits, including how frequently you’ve been passing stool
• performing a physical exam where they look for bloating and other signs
• reviewing your personal and family medical history
• asking you about medications you’re taking

They can use a digital rectal examination to confirm fecal impaction. During this test, a doctor inserts a gloved finger with lubrication gel into your rectum to feel the buildup of stool.

You may also receive imaging tests, such as a computed tomography (CT) scan if a doctor suspects you have fecal impaction farther up in your colon. Rarely, they might use a barium enema or sigmoidoscopy.

How are fecal impaction and constipation treated?

Fecal impaction treatment

Here’s a look at the treatment options for fecal impaction.

Manual disimpaction

Manual disimpaction is often required. During this procedure, a doctor inserts a lubricated gloved finger into your anus and gently removes the impacted stool with their index finger. They may also use a device called an anoscope or suction.

Enema for fecal impaction

An enema may be required if the stool is too deep in your bowel to be treated with manual disimpaction. An enema involves injecting a fluid into your rectum to loosen the impacted stool either at home or in a doctor’s office.

Laxatives

A doctor may recommend that you drink a laxative called polyethylene glycol. You may have to consume 1–3 liters (0.26–0.79 gallons) of this substance over several hours.

Fecal impaction surgery

Surgery isn’t commonly needed for fecal impaction but may be required if you have a complete blockage of your bowel.

Constipation treatment

Treatment for constipation includes:

• eating more fiber
• drinking plenty of liquids
• getting regular physical activity
• stopping certain supplements or medications
• taking over-the-counter medications, such as:
  • fiber supplements
  • osmotic laxatives
  • stimulant laxatives
  • bulk-forming laxatives
  • lubricants
  • stool softeners
• prescription medications
• bowel retraining therapy

How to prevent fecal impaction and constipation

The best way to prevent fecal impaction is to prevent constipation. You can prevent constipation by:

• eating plenty of high-fiber foods like fruits and vegetables
• drinking plenty of water
• exercising regularly
• considering adding probiotics to your diet
• minimizing alcohol and caffeine intake

Frequently asked questions about fecal impaction and constipation

Here are some frequently asked questions people have about fecal impaction and constipation.

Will impacted stool eventually come out?

Impacted stool often doesn’t come out on its own and requires medical treatment to prevent potentially serious complications.

How do you know when fecal impaction has cleared?

You’ll likely have immediate relief of your symptoms following the clearing of fecal impaction, including reduced bloating and abdominal pain or rectal pain.

What is the best laxative for impacted stool?

Polyethylene glycol is the ideal laxative for fecal impaction. Another laxative that’s sometimes used is magnesium citrate.

Takeaway

Constipation is when you have trouble passing a bowel movement. Fecal impaction is a potential complication of constipation that occurs when hardened stool becomes lodged in your bowel.

Both conditions are common among older adults. Eating plenty of fiber, exercising regularly, and staying hydrated can help you prevent both conditions.