II. Definition

  1. Firm, hard, dry immovable stool in Rectum or distal colon creating a partial or complete blockage

III. Risk factors

  1. Elderly
  2. Immobile patients
    1. Incidence 1% in hospitalized patients
  3. Spinal Cord Injury patients
    1. Incidence: 13%
  4. Chronic Opioid use
  5. Hypothyroidism
  6. Low fiber diet

IV. Symptoms

  1. Constipation
  2. Diarrhea
    1. Frequent passage of small loose or liquid stools
    2. Results from leakage of stool around the impaction
    3. May result in overflow Fecal Incontinence

V. Signs

  1. Firm, immovable mass of stool on Rectal Exam

VI. Imaging: Abdominal XRay

  1. Large stool collection in Rectum and sigmoid colon

VII. Differential Diagnosis

VIII. Precautions: Red Flags suggesting other diagnosis

IX. Management

  1. Disimpaction with Rectal Exam
  2. Warm water or saline lavage
    1. Instill by rectal tube or Flexible Sigmoidoscopy
  3. Mineral Oil Enema (or oral if no risk of aspiration)
  4. Dilatation of anus under general Anesthesia
  5. Oral Polyethylene Glycol (Miralax)
    1. Effective in 89% of cases
    2. Chen (2005) 21(10): 1595-602 [PubMed]

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