Fecal Impaction
Hardened stool mass stuck in the rectum or sigmoid colon
Definition
Fecal impaction is the accumulation of hardened, dried stool in the rectum or colon that cannot be evacuated naturally. It most often complicates chronic constipation.
Risk Factors
- Immobility, dehydration, low-fiber diet
- Opioid medications
- Anticholinergic medications
- Elderly, cognitively impaired
- Neurologic disorders (Parkinson's, SCI)
Signs and Symptoms
Abdominal distention, anorexia, nausea, vomiting, cramping, rectal pressure, overflow incontinence (paradoxical liquid stool leaking around impaction), and urinary retention from pressure.
Nursing Interventions
- Manual disimpaction (with order) after lubrication and possibly numbing. Monitor for vagal response (bradycardia)
- Oil-retention enema or mineral oil
- Tap water or saline enema
- Increased fluids and dietary fiber
- Stool softeners (docusate), osmotic laxatives (polyethylene glycol)
- Prevent recurrence: scheduled toileting, exercise, hydration, fiber
NCLEX Relevance
Liquid stool leaking around impaction is a classic red flag.