View source for Fecal impaction

==Background==
[[File:Rectum anatomy en.png|thumb|Anatomy of the anus and rectum.]]
*Typically a complication of chronic constipation that results in the accumulation hardened fecal matter in the colon or rectum that cannot be spontaneously evacuated

===Risk Factors===
*Elderly and young age
*Chronic [[constipation]]
*Lifestyle factors (immobility, low fiber diet, dehydration)
*Medications that impair GI motility ([[anticholinergics]], [[antipsychotics]], [[opioids]])
*Anatomic abnormalities ([[colorectal cancer|malignancy]], [[anorectal disorders|anorectal disease]], [[Hirschsprung's disease]])
*Neurologic conditions ([[dementia]], [[spinal cord injury]], [[cerebral palsy]])

==Clinical Features==
===History===
*[[Abdominal pain]] or bloating
*[[Nausea and vomiting]]
*Obstipation
*[[Agitation]]/[[confusion]] (elderly patients with neuropsychiatric conditions)
*[[Urinary incontinence]]
*Overflow stool incontinence

===Physical exam===
*Abdominal distention and/or [[abdominal pain|tenderness]]
*Palpable firm stool balls on digital rectal exam

==Differential Diagnosis==
{{Constipation DDX}}

==Evaluation==
[[File:PMC5318312 12245 2017 134 Fig1 HTML.png|thumb|Pelvic CT scan showing a large fecal impaction (arrow).]]
*Digital rectal exam
*Chemistry to evaluate for [[hypokalemia]] or [[hypercalcemia]]
*TSH if indicated
*[[Abdominal X-ray]] to evaluate for air-fluid levels and free-air
*CT if severe presentation
**[[Stercoral colitis]] is CT finding caused by impacted fecal material causing pressure edema and ischemia on the bowel wall. Left untreated, the condition can lead to wall ischemia, ulceration, and perforation.<ref> Ünal E, Onur MR, Balcı S, Görmez A, Akpınar E, Böge M. Stercoral colitis: diagnostic value of CT findings. Diagn Interv Radiol. 2017;23(1):5-9.</ref>
***Findings include colonic wall thickening, pericolonic fat stranding, and extraluminal bubbles of gas or abscess (signs of perforation); all of which are not found in uncomplicated fecal impaction.

==Management==
*Surgery if there are signs of perforation, peritonitis, or stercoral colitis
*Distal impactions - manual disimpaction and/or rectal suppositories or enemas
*Proximal impactions typically respond better to oral laxatives
*After initial disimpaction, address risk factors and initiate a maintenance bowel regimen

==Disposition==
*Consider admission for patients with [[stercoral colitis]] for aggressive bowel regimen and washout

==See Also==
*[[Constipation]]


==References==
<references/>

[[Category:GI]]