Faecal impaction is the build-up or accumulation of stool in the large intestine. It is therefore also alternatively called fecal congestion or stool impaction. The English terms are coprostasis or fecal impaction.
What is faecal impaction?
Faecal impaction is generally accompanied by severe pain in the lower abdomen. They usually occur on the right side and intensify as soon as there is a defecation reflex. See AbbreviationFinder for abbreviations related to Faecal Impaction.
The faecal impaction is not actually a disease. Rather, as a symptom, it represents a serious disturbance of the final digestion and thus a serious health problem. The stool in the rectum is not transported further in affected patients and accumulates primarily in the last area of the rectum, the rectum.
A steady dehydration of the stool follows, causing the feces to thicken and solidify. The result is water-poor, hardened balls of feces, also called skybala in medical terms. These bound balls of feces gradually close the intestines and mean that the affected person can only empty his intestines in fragments.
If the ball of faeces, similar to a plug, completely settles, it is no longer possible to defecate, even under pressure. The removal of water from the intestinal contents continues and faecal stones are formed. These stone-like structures consist of massive and thickened stool. They are surrounded by a layer of mucus and dried stool residue.
Causes
Faecal impaction usually develops from chronic constipation. The civilization disease constipation, commonly known as constipation, has a wide variety of causes. For the most part, a low-fiber, dry diet and a simultaneous lack of exercise (including bed rest and immobilization) are the triggers for constipation. In addition, intestinal diseases such as abscesses, adhesions, hemorrhoids or even tumors can be the reason for constipation.
But nerve diseases such as Parkinson’s or multiple sclerosis, muscle diseases and hormone fluctuations during pregnancy are also possible causes of constipation. Ultimately, even the side effects of medication should not be underestimated. Antidepressants, opiates and antiepileptics, among other things, repeatedly lead to unwanted constipation.
In elderly patients, the cause of faecal impaction is often insufficient fluid intake. In addition, with increasing age, the rectal musculature slackens and at the same time the intestinal peristalsis is often disturbed. Faecal impaction can also develop as a result of acquired or congenital megacolon (enlarged intestine) and after an intestinal obstruction.
Symptoms, Ailments & Signs
Faecal impaction is generally accompanied by severe pain in the lower abdomen. They usually occur on the right side and intensify as soon as there is a defecation reflex. Especially in a sitting position, this empty bowel reflex leads to pain from balled faeces and faecal stones. Those affected also complain about pronounced meteorism.
This accumulation of intestinal gases causes intense and therefore uncomfortable flatulence. On the other hand, nausea and vomiting associated with faecal impaction occur less frequently. In connection with the pain on the right side, however, this is often the cause of confusion with appendicitis (appendicitis). A corresponding clarification with a specialist should be carried out.
Particular caution is required if there is a feigned diarrhea, in which colon secretions escape past the fecal obstruction. It can be followed by fecal incontinence, which makes it impossible to hold the stool and defecate voluntarily.
Diagnosis & History
A diagnosis can only be made by a specialist. In the best case, the dog can already feel the hardened balls of feces and fecal stones through the exposed abdominal wall, which are referred to hereafter as koprom or sterkoroma. However, only an X-ray of the abdominal region provides a clear finding.
Complications
Significant complications can occur with faecal impaction. Due to the accumulation of feces in the intestine, there is a risk of intestinal infection, so-called transit peritonitis can also occur. First, however, there is diarrhea and nausea, often accompanied by constipation and other intestinal problems.
In the further course, untreated faecal impaction can cause an intestinal obstruction, which is often life-threatening for the patient. In less severe cases, faecal impaction leads to urinary incontinence and later to fecal incontinence. In the advanced stage, faecal impaction often leads to severe intoxication and infections in the intestine.
This initially leads to circulatory problems, later life-threatening organ disorders and other complications occur. These include: proctalgia, bowel obstruction and appendix rupture, depending on the underlying condition and the time of treatment. Stagnation also increases the risk of faecal stones, which prevent the intestine from emptying completely and thus promote a variety of gastrointestinal diseases such as infections and constipation.
If faecal impaction is treated early, there are usually no long-term complications. Laxative preparations can lead to deficiency symptoms, dehydration and physical exhaustion in the short term, while surgical interventions carry the risk of injuries to the intestines.
When should you go to the doctor?
In the case of severe discomfort in the lower abdomen, even if it occurs on the right side, most people think of harmless symptoms that you may associate with a temporary problem with stool (constipation). However, these complaints are usually not harmless abdominal pain and should therefore at least be discussed with a doctor, who can then determine any further examinations that may be necessary after an initial diagnosis. If the all-clear can then be given, there is at least a reassuring clarity.
If the pain occurs particularly when sitting or if pronounced meteorism (accumulation of intestinal gases) is noticed, a specialist should be consulted immediately so that a differentiated diagnosis can be made on the basis of special intestinal examinations. The intense flatulence that often occurs at the same time underlines the urgency of a medical consultation.
As with appendicitis (inflammation of the appendix), right-sided lower abdominal pain can lead to vomiting and nausea. A precise distinction between faecal impaction and appendicitis must be made immediately by a specialist.
If colon secretions leak out or even faecal incontinence occurs, you need to see a doctor as soon as possible.
Treatment & Therapy
The treatment of faecal impaction should also be left to a specialist. Self-therapy with laxatives or home remedies is not recommended for the most serious form of constipation, since the result can be an intestinal obstruction (medically ileus) as well as an intestinal infection, peritonitis and so-called autointoxication. Autointoxication is a state of intoxication caused by bacterial invasion.
Decomposition substances from the intestinal contents get into the bloodstream and cause fever, headaches, exhaustion and a weakening of the immune system. Older people, children and people with a weakened immune system in particular should therefore seek help immediately in the event of faecal impaction.
Treatment of faecal impaction is carried out depending on the severity and condition of the patient. Mild cases are treated with enemas and controlled intake of laxatives. Oral administration of a PEG solution and subsequent orthograde colonic irrigation are common.
In more severe cases, a digital stool evacuation is carried out. Here, the faecal plug is removed manually by a specialist and then a cleansing enema is carried out. Stool evacuation is usually painful for the person concerned. Surgical intervention and taking painkillers are resorted to only in exceptional cases.
In order to prevent faecal impaction from becoming chronic, once the intestines have been completely emptied, the formation of faecal balls must be stopped and the stool consistency regulated. In children, chair training has proven itself in this regard.
Outlook & Forecast
In most cases, faecal impaction causes severe pain in the lower abdomen. The pain is usually worse when sitting. In addition to the pain, intestinal gases also accumulate in the patient, which can lead to unpleasant feelings of pressure in the abdomen and unpleasant odours.
Faecal impaction can be diagnosed relatively well by a doctor with the help of an X-ray. In addition, the doctor can also feel the presence of the fecal balls with his hand. If the symptom is not treated, it can lead to a life-threatening bowel obstruction. In the worst case, this can also lead to incontinence. In addition, there are a number of infections and inflammations in the intestines, which lead to severe pain.
In most cases, treatment is through medication. If this is started early, there will be no further complaints or complications. Only in serious cases is an operation necessary to clean the intestines. However, faecal impaction can occur again after treatment and is therefore not completely ruled out.
Prevention
Otherwise, adequate fluid intake and a high-fiber diet with grains, vegetables and legumes are among the most common preventive measures. Active exercise and weight reduction if you are overweight also promote intestinal activity.
However, if you are prone to constipation and faecal impaction, light colonic irrigation is recommended. They loosen hardened areas and keep the intestinal walls supple. As a precaution, children and patients with circulatory problems should consult their family doctor or specialist before use. Long-term use of laxatives is strongly discouraged. Despite apparent success, laxatives can promote faecal impaction.
Aftercare
In the case of faecal impaction, the person affected usually has very few or no special follow-up measures available. First and foremost, the disease must be recognized and treated very quickly. Of course, the reason for the faecal impaction should also be avoided, although the disease can have various causes.
A causal treatment must therefore also be carried out so that the disease can be completely cured. Most of those affected are dependent on taking laxatives. It is important to ensure that the dosage is correct so that poisoning does not occur. However, if the symptoms do not subside with the conservative methods, a doctor must be consulted again to prevent a complete blockage of the intestine.
In some cases, an operation is necessary to alleviate the symptoms. After such an operation, bed rest should be observed in any case. Only light food should be taken so as not to burden the intestines. The diet can then return to normal over time. Possibly the coprostasis can lead to a reduced life expectancy of the affected person.
You can do that yourself
There are good self-treatment options against the accumulation of feces in the large intestine. In principle, however, it should be noted that the therapy should be carried out under the supervision of a specialist. The uncontrolled use of home remedies and laxatives can lead to more serious diseases such as a blockage or infection of the intestine, peritonitis or poisoning from invading bacteria.
People suffering from faecal impaction should increase their intake of liquids and high-fiber foods such as cereals, vegetables and legumes. Laxative foods such as sauerkraut, pineapple and sour milk are also advisable. In acute cases, drinking plenty of water helps. Taking a tablespoon of olive oil before breakfast also increases the slipperiness of hard stools considerably.
A lot of exercise keeps the intestines active, strengthens the rectal muscles and prevents the formation of faecal balls or columns of faeces. Daily abdominal massages are also an option as it improves the shape, location and tone of the digestive system muscles. If you are prone to faecal impaction, regular light colonic irrigations are recommended. This loosens hardened areas and keeps the intestinal walls supple. Under no circumstances should laxatives be used continuously. Although these preparations often provide short-term relief, they increase faecal impaction in the long term. Under certain circumstances, these agents even cause faecal congestion in the first place.
