II. Definition
- Firm, hard, dry immovable stool in Rectum or distal colon creating a partial or complete blockage
III. Risk factors
- Elderly
- Immobile patients
- Incidence 1% in hospitalized patients
-
Spinal Cord Injury patients
- Incidence: 13%
- Chronic Opioid use
- Hypothyroidism
- Low fiber diet
IV. Symptoms
- Constipation
-
Diarrhea
- Frequent passage of small loose or liquid stools
- Results from leakage of stool around the impaction
- May result in overflow Fecal Incontinence
V. Signs
- Firm, immovable mass of stool on Rectal Exam
VI. Imaging: Abdominal XRay
- Large stool collection in Rectum and sigmoid colon
VII. Differential Diagnosis
VIII. Precautions: Red Flags suggesting other diagnosis
- Fever
- Bloody Diarrhea
- Leukocytosis
IX. Management
- Disimpaction with Rectal Exam
- Warm water or saline lavage
- Instill by rectal tube or Flexible Sigmoidoscopy
- Mineral Oil Enema (or oral if no risk of aspiration)
- Dilatation of anus under general Anesthesia
- Oral Polyethylene Glycol (Miralax)
- Effective in 89% of cases
- Chen (2005) 21(10): 1595-602 [PubMed]