Fecal impaction is a serious condition requiring prompt action. First-line treatments include warm saline or mineral oil enemas to soften stool and manual disimpaction using lubricated gloves. For persistent cases, stimulatory suppositories like bisacodyl (10 mg) may aid rectal passage. Prevent recurrence with a high-fiber diet, adequate hydration, regular physical activity, and maintenance of stool softness using oral osmotic laxatives like polyethylene glycol.
January 10, 2025

Severe Constipation & Fecal Impaction: What to Do

Evidence-Based At-Home Care Guide

William Shen

William Shen

Co-founder & CPO

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Fecal impaction is the accumulation of hardened stool in the rectum or colon, causing obstruction and potential complications like bowel perforation. Impaction is likely if you have not defecated for days and if you can feel hard stools in your rectum. 

Rectal discomfort and leakage of liquid stool around the impaction can occur.

Warning: Seek medical attention rather than trying to treat fecal impaction at home as you are at risk of bowel perforation or serious infection if you have any of the following risk factors or symptoms:

  • Abdominal pain, bloating, or distension

  • Fever or confusion

  • Have diabetes, bleeding disorders, or organ dysfunction

First-line recommendations:

  • Enemas: Warm saline or mineral oil enemas to soften stool. Mineral oil gentle enema (FDA M007).

  • Manual disimpaction: With lubricated gloved fingers. Insert lubricated gloved index finger into the rectum. Manually break up stool using a scissoring motion. Gently extract fragments using circular motions with the finger bent. Water-soluble and sterile lubricant packs. 

Second-line recommendations: 

  • Stimulatory suppositories: Bisacodyl 10 mg can be added once to stimulate rectal passage of stool. Wait 15 minutes to an hour and repeat enema and/or manual disimpaction if needed. Bisacodyl 10 mg stimulant suppository (FDA M007 Class III).

Prevention of recurrence:

  • Oral osmotic laxatives (e.g., polyethylene glycol 17 g daily) after resolution. Avoid chronic laxative dependence. Ask a doctor before using more than a few weeks at a time. MiraLAX PEG osmotic laxative (FDA NDA 22015).

  • High-fiber diet (20-30 g/day) with copious fluid intake. Psyllium Husk Fiber Supplement (FDA M007).

  • Regular physical activity.

Citation

Hussain ZH, Whitehead DA, Lacy BE. Fecal Impaction. Curr Gastroenterol Rep. 2014; 16(9). doi: 10.1007/s11894-014-0404-2

Johns, J., Krogh, K., Rodriguez, G. M., Eng, J., Haller, E., Heinen, M., ... & Korsten, M. (2021). Management of neurogenic bowel dysfunction in adults after spinal cord injury: clinical practice guideline for health care providers. Topics in Spinal Cord Injury Rehabilitation, 27(2), 75-151.

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