The Digestive Tract
The digestive tract is one of the human organ systems responsible for extracting nutrients and processing food. Normal work of the gastrointestinal tract is characterized by excretion about once a day with a regular consistency of feces. Violation of the norm is manifested with more frequent or infrequent emptying on an ongoing basis, with more solid (constipation) or more liquid (diarrhea) feces. One of the consequences of constipation, if not adequately treated, can be fecal impaction. It is characterized by plugging in the form of solid feces, which closes the colon’s lumen and can lead to the impossibility of emptying and has some complications.
Fecal Impaction and Its Reasons
Fecal impaction differs from constipation because it poses a more severe threat to the normal functioning of the digestive tract. It is a consequence of prolonged constipation, which has several causes. They include malnutrition, hormonal imbalance, disruption of peristalsis, metabolic disorders, and pancreas malfunction. A fecal impaction is the prolonged retention and buildup of feces in the rectum; feces are hard or putty-like (footnote). Sizes vary from three centimeters or more; their shape can be either round or oval, or irregular (Sorrentino & Remmert, 2020). Usually, fecal plugs are characterized by the presence of chemical elements that indicate improper nutrition.
The Symptomatology
The symptomatology of the disease is manifested in the complete absence of defecation for more than three days and constant flatulence. Among the secondary symptoms are the hardness and soreness of the abdomen and intestinal obstruction; moreover, it may be accompanied by weakness, headache, and malaise. When the fecal impaction reaches a critical size, the symptoms intensify and manifest themselves in severe stomachache and gastric bleeding. It formulates the complication of the disorder. In this case, urgent hospitalization is necessary, and home treatment is impossible. It is expressed primarily by restless behavior and lack of stool in children: if the child is constantly crying and has not been emptied for a long time, these are reasons to visit a doctor.
Complications of Fecal Impaction
The complications of fecal impaction include Strong stomachache and gastric bleeding in case of critical size of impaction.
Home treatment is impossible in this case is impossible, however, it depends on the individual and the course of the disease. Sometimes hospitalization is not necessary even with such symptoms.
Furthermore, fecal impaction can lead to some other complications. In severe forms, fecal peritonitis may occur, ingesting intestinal contents into the abdominal cavity. It is accompanied by a delay in stool and gas, intense abdominal pain, nausea and vomiting, difficulty in movement, fever, and severe malaise are also observed. In addition, a stool plug can lead to intestinal obstruction: mechanical disturbance or complete impossibility of moving the masses through the intestines. It may have serious consequences up to bowel obstruction, and clinical manifestations include acute cramping pain, nausea, vomiting, and malaise.
Statistics
Fecal impaction and its effects on health have been the subject of some research, although further studies in this area are still needed. According to Falcon et al. (2016), fecal impaction (FI) is common in the elderly and other at-risk groups, such as patients with neuropsychiatric disease. The study included an analysis of 280 clinical cases of fecal impaction and their consequences of varying severity (footnote). Thus, 43,5 % of patients were over 65 years old, which indicates the influence of age on the chance of developing an illness: in most cases, a fecal plug develops in older persons. In 29 % of clinical cases of the study, the individual had an underlying disease of neuropsychiatric nature. In other words, one established that the development of fecal plugs may be a consequence of some mental abnormalities or organic lesions of the brain. In 15% of cases, there was a necessity for hospitalization.
Types of Complications
The study also included an analysis of complications caused by fecal impaction. In total, data were collected from 346 cases of complications of FI (Falcon et al., 2016). One divided them according to gastrointestinal tract involvement and classified them based on pathophysiological and anatomical mechanisms. In total, there were three groups of complications: effect on the intestinal wall (73.4 %), on the intestinal lumen (14 %), and adjacent structures (12.6 %).
Intestinal Perforation
Intestinal perforation may be another dangerous complication of fecal impaction. This is an opening in the wall of the gastrointestinal tract, arising, in this case, due to excessive pressure of the plug. It is accompanied by acute abdominal pain, usually of a constant nature. Heart palpitations, sepsis, fever, and confusion may occur. Moreover, Abcarian et al. (2017) argue that fecal impaction may be accompanied by liquid discharge after 5-6 days of constipation. The problem is that many may confuse it with diarrhea and make the situation worse by taking the wrong medications. In fact, solid masses remain in the intestines; sometimes, the stomach gets rid of the water secreted by the stuck masses in this way. It is a bad signal as dehydration aggravates the hardening of the stool.
References
Sorrentino, S. A., & Remmert, L. (2020). Mosby’s textbook for nursing assistants. (10th ed.). Elsevier Health Sciences.
Abcarian, H., Cintron, J., & Nelson, R. (2017). Complications of anorectal surgery: prevention and management. Springer.
Falcon, B. S., Lopez, M. B., Munoz, B. M., Sanchez, A. A., & Rey, E. (2016). Fecal impaction: a systematic review of its medical complications. BMC Geriatrcis 4, 16.