Fecal Impaction

Inability to defecate for days or weeks

Normal bowel sounds

Distended, tympanitic abdomen

DRE: hard, impacted stools distending the rectum

Tenesmus

Clinical diagnosis

Abdominal x-ray (to rule out bowel perforation)

• Findings:

  • Dilated bowel loops

  • Fecal shadows in the colon and rectum

  • Air-fluid levels may be visible.

Rule out bowel perforation.

Manual disimpaction

Administer osmotic enema (e.g., warm water enema or mineral oil enema).

Consider the addition of stimulatory suppositories

Prevention of recurrence

• Start maintenance bowel regimen with osmotic laxative.

• Stop contributing medications.

• Lifestyle modifications

• See “Treatment.”

For severe cases, consult surgery.