Impacted Bowel: Causes and Treatments

Impacted Bowel: Causes and Treatments


An impacted bowel, also known as fecal impaction, is a large, hard mass of stool that gets stuck in the rectum (the lowest part of the colon, or large intestine). It prevents you from having a bowel movement.

An impacted bowel is typically triggered by a long bout of constipation and often includes symptoms like cramping and bloating.

Experiencing an impacted bowel is more common in people who have chronic constipation, which is estimated to affect up to 12% of adults in the United States. Treatment options like an enema, laxative, or manual removal of the stuck lump of stool can usually fully resolve it. Early treatment can reduce the risk of complications.

Multiple symptoms can accompany an impacted bowel. This might include:

  • Bloating: This can include a feeling of stomach fullness, visible swelling, and overall discomfort.
  • Cramping: Painful cramping may take over more than half of the abdominal area and might continue to become more severe.
  • Loose stools: You might experience a sudden bout of watery diarrhea during long-term constipation. This happens when hard stools eventually stretch and weaken the rectal muscles, allowing watery and other built-up stool to leak out.
  • Rectal bleeding: You might see blood when using the toilet. The act of straining to pass hard stools can tear the skin inside of the anus, leading to bleeding.

If you can pass any stool, you may notice that your poop appears small and semi-formed—a sign of constipation. The shape and consistency of healthy poop is typically smooth, soft, and sausage or snake-shaped.

An impacted bowel usually happens when you’ve been constipated for a long period of time. There are several underlying causes of chronic (long-term) constipation.

Diet

Diet plays a big role in keeping bowel movements regular. Not getting enough fiber daily or eating a high-fat diet can make you more likely to develop chronic constipation—and potentially, an impacted bowel. A lack of fluids and dehydration can also lead to dry, hard stools.

Lifestyle Factors

Many other causes of chronic constipation involve lifestyle factors.

For example, older adults and people who live in assisted living facilities often experience an impacted bowel due to a lack of daily exercise and a mostly sedentary routine. In these circumstances, the stool moves more slowly through the digestive tract, partly due to weakened abdominal muscles.

Frequent traveling, which can lead to irregular bowel movements, and ignoring the urge to use the bathroom can also lead to stool blockages.

Health Conditions

Certain health conditions are known to trigger chronic constipation and increase the risk of an impacted bowel. Conditions like the following can prevent you from producing normal bowel movements—which over time may result in an impacted bowel:

  • Kidney failure
  • Neurological (brain-related) disorders, including dementia, Alzheimer’s disease (AD), and Parkinson’s disease (PD)
  • Spinal cord injury
  • Thyroid disease

Medication Side Effects

A variety of medications include constipation as a side effect because of how they slow down digestive tract movement. Taking certain medications over a long period of time can lead to an impacted bowel.

These medications include:

  • Anticholinergics (treat conditions like gastrointestinal disorders and respiratory disorders that can affect nerve signals to the bowel muscles)
  • Anticonvulsants (treat and prevent seizures)
  • Antacids that contain aluminum and calcium
  • Anti-diarrheal medications
  • Calcium channel blockers (lower blood pressure)
  • Diuretics (help the body get rid of excess water and salt)
  • Iron supplements
  • Opioids

While it may seem counterintuitive, laxatives can also have this effect. That’s because if they’re taken too frequently, they can prevent your body from remembering how to have a normal bowel movement.

Reach out to a healthcare provider if you’ve been experiencing chronic constipation for several days, a week, or longer.

While an impacted bowel is more common in older adults and people with certain health conditions, infrequent bowel movements can increase your risk.

Tell your healthcare provider if you’re experiencing:

  • Diarrhea after a long period of constipation
  • Abdominal pain and bloating
  • Blood in your stool
  • Sudden constipation with abdominal cramping and an inability to pass gas or stool
  • Thin, pencil-shaped stools

The provider will examine your stomach and rectum to confirm that there’s a stuck lump of stool and then recommend a course of treatment. They will refer you to gastroenterologist (a medical doctor who specializes in the digestive system) for a colonoscopy if your bowel habits have recently or suddenly changed. In rare cases, this may indicate colon or rectal cancer.

The main goal of impacted bowel treatment is to remove the stuck lump of stool. This can be done in several ways:

  • Manual disimpaction: A healthcare provider can manually break up the mass of stool by inserting a gloved finger or two into the rectum. Lubrication or a suction tool may help make this process easier.
  • Enema: Injecting fluids containing a mineral solution into the rectum can help stimulate and cleanse the colon.
  • Oral laxatives: Oral laxatives like Dulcolax (bisacodyl) and MiraLax (polyethylene glycol) come in tablet or powder form. When taken by mouth, these drugs stimulate the lump of stool to pass.
  • Suppositories: Over-the-counter (OTC) glycerin or bisacodyl suppositories are inserted into the rectum. They trigger stool softening and, eventually, a bowel movement.

Surgery for an impacted bowel is rare and usually only required in cases where there’s a complete bowel blockage.

Prevention tips can help lower your risk of experiencing an impacted bowel.

For example, staying hydrated and including fiber-rich foods in your diet can improve bowel regularity by supporting digestion.

Exercising regularly, if possible, is another key prevention factor. Research suggests that physical activity supports movement in the digestive tract.

Talk to a healthcare provider about whether you should continue taking medications that may contribute to constipation—like opioids (prescription pain-relieving medications) or anticholinergics (drugs used to treat conditions like depression, Parkinson’s disease, and muscle spasms). Your provider might want to adjust your dose or consider alternative medications if you experience severe constipation.

Timely treatment for an impacted bowel is usually successful.If left untreated, an impacted bowel can lead to serious (though rare) health complications. These include:

  • Bowel ulceration: Ulcers that develop in the lining of the colon
  • Rectal tissue injury: Can look like small tears in or trauma to the tissue lining the anus
  • Fecal incontinence: Inability to control bowel movements

You may be able to avoid impacted bowel complications by taking steps to prevent constipation in the first place. You may want to be particularly mindful of this if you:

  • Are older or reside in a nursing home
  • Have a neurological condition like dementia, AD, or PD
  • Take medications that include constipation as a side effect
  • Use laxatives frequently
  • Have a structural or functional gastrointestinal (GI) condition

An impacted bowel, also known as fecal impaction, is a stuck lump of stool in the digestive tract. It’s commonly caused by long-term constipation. Symptoms include stomach cramping, bloating, and stool leakage.

A healthcare provider can help diagnose this condition and treat it with manual blockage removal, an enema, or laxatives.

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