Fecal Impaction: What Is It and How Is It Treated?

Medically Reviewed by Brunilda Nazario, MD on December 29, 2022
5 min read

A fecal impaction is a large, hard mass of stool that gets stuck so badly in your colon or rectum that you can’t push it out. This problem can be very severe. It can cause grave illness or even death if it’s not treated. It’s more common among older adults who have bowel problems.

Fecal impaction becomes more likely to happen when you’re elderly. There are a few common reasons why you could have this problem:

Constipation. Fecal impaction can sometimes develop if you’re constipated– meaning you have the urge to make a bowel movement but can’t follow through – and don’t receive any treatment.

Laxatives. If you take laxatives too often, you could keep your body from “knowing” when it’s time to have a bowel movement. Your body will be less likely to respond to the urge to go, and stool may build up in your colon or rectum.

Other medicines. Some opioid drugs that treat pain can slow down your digestion, making stool more likely to build up in your colon.

Activity level. If you’re not active, you’re more likely to be constipated and have a fecal impaction than people who move around during the day.

Bathroom habits. If you often hold in your bowel movements because you don’t have access to a toilet when you need one, or you don’t want to go when you’re in a strange place, it could lead to a fecal impaction over time.

Often, if you have a fecal impaction, chances are you’ve been constipated for a while. And then suddenly, you might have other symptoms, including:

  • Very watery diarrhea that leaks or explodes out
  • Diarrhea or stool that leaks out when you cough or laugh
  • Back or stomach pain
  • Little or no urine (and no urge to pee)
  • A swollen belly
  • A too-fast heartbeat (tachycardia)
  • A fever
  • Confusion

If you’ve been constipated and have any of these problems, contact your doctor right away. They should let you know whether you’re having an emergency and should call 911 for help. Many people with fecal impaction are very old or have other grave illnesses, so this problem may be life-threatening.

Call 911 right away if you have trouble breathing, a fast or irregular heartbeat, or are dizzy or confused.

There are several ways that your doctor can find out if you have a fecal impaction.

Medical history. Your doctor will ask how often you go to the bathroom, when you last went, and whether it was hard. They’ll need to know if you’re often constipated and how often you use laxatives. Other questions you can expect: How much water and other liquids do you drink, how much fiber do you eat, and what medications do you take?

Physical exam. Your doctor should check your overall health and perform a digital rectal exam. To do this, your doctor will put on gloves, add lubricant (a slippery gel) to one finger, then insert their finger into your rectum to feel for a fecal impaction or other problems.

X-ray. Your doctor may be able to spot a fecal impaction by taking X-ray images of your belly.

Sigmoidoscopy. During this test, your doctor uses a sigmoidoscope (a thin, tubelike instrument with a light and a lens) to look for problems inside your lower colon in the area closest to your rectum. They will inspect the colon for a fecal impaction or something else that’s causing your symptoms.

When you have a fecal impaction, you’ll need to have the hard mass of stool removed from your colon or rectum to get better. It won’t go away on its own, and it can lead to death if it’s allowed to worsen.

Enema for fecal impaction

The most common treatment for a fecal impaction is an enema, which is a special fluid that your doctor inserts into your rectum to soften your stool. An enema often makes you have bowel movements, so it’s possible that you’ll be able to push out the mass of stool on your own once it’s been softened by the enema.

Sometimes, if an enema alone doesn’t do the trick, the stool must be broken up and removed by hand.

Once the hard mass of stool is removed, your bowel habits should return to normal as long as you manage your future chances for constipation.

There are things you can do to help reduce your chances of fecal impaction:

  • Take any stool softeners (medicine that makes it easier to pass) that your doctor prescribes.
  • Stay active, even if you just go for a daily walk.
  • Drink plenty of water and eat high-fiber foods to keep your bowels regular.
  • Ask your doctor whether medicines you’re taking could cause problems.

Your doctor may recommend some lifestyle changes as part of your hard stool treatment. The intent is usually to increase the speed of your bowel movements.

Getting more fiber

You may be asked to make diet changes that include more fruits and vegetables during your meals. Other recommendations for adding fiber often include eating whole-grain cereals and bread. Your doctor may have specific advice about the amount of fiber you should try to consume each day. 

Starting an exercise routine

Physical activity can help increase muscle activity in your intestines. Ask your doctor how many days per week you should try to exercise. Make sure the program does not worsen your overall health. 

Taking supplements

Your doctor may tell you to start taking laxatives to soften your hard stool and ease your bowel movements. There are a variety of laxatives on the market that may work, depending on your circumstances, including: 

  • Fiber supplements to bulk up your stool
  • Stimulants that help your intestine contract
  • Osmotics that increase the fluid secretions in your bowels to help stimulate bowel movements
  • Lubricants that ease the passage of stool through your colon
  • Stool softeners that draw water into hard stools from your intestine
  • Enemasand suppositories to soften stools and stimulate a bowel movement