What Are the Signs of an Impacted Bowel?

An impacted bowel often happens when people are chronically constipated and use laxatives. Fecal impaction is more prone to occur if laxatives are suddenly stopped because the intestinal muscles are no longer able to move stool or feces on their own.

Risk factors for developing chronic constipation and an impacted bowel include:

• Being sedentary
  • Especially people who do not move around much and spend most of their time in a chair or bed
• Brain or nervous system disease that damages the nerves that serve the muscles of the intestines
• Medications that slow the passage of stool through the bowels
  • Anticholinergics
  • Diarrhea medicines, when taken too often
  • Narcotic pain medicines such as methadone, codeine, and oxycontin 

An impacted bowel is diagnosed with a patient history and physical examination, which includes pressing on the abdomen along with a digital rectal examination in which a doctor places a gloved finger inside the rectum. If a person has an impacted bowel, the doctor will find a hard mass and/or a large amount of stool in the rectum. 

Other tests used to help diagnose an impacted bowel include: 

• Abdominal X-ray
• Colonoscopy 

Treatment for an impacted bowel involves removing the impacted stool. This may involve: 

• Warm mineral oil enema to soften and lubricate the stool
  • Most of the time, enemas alone are not enough to remove a large, hardened fecal impaction 
• Manual removal, in which the mass is broken up by hand 
  • A healthcare provider will insert one or two fingers into the rectum and slowly break up the mass into smaller pieces so it can be removed
  • Suppositories may be given to help clear the stool
• Local anesthesia with abdominal massage
  • This helps relax the anal canal and pelvic floor muscles to pass the mass 
• Colonoscopy may be needed

Surgery is rarely needed to treat an impacted bowel. A megacolon (very wide colon) or complete bowel blockage may need to be treated with emergency removal of the impaction.

A bowel retraining program is needed in most cases for patients with an impacted bowel. Patients are asked about diet, bowel patterns, laxative use, medicines, and medical problems, and changes may be recommended along with special techniques to retrain the bowel.