GASTROINTESTINAL DYSFUNCTION: COLON AND ANORECTUM: FECAL IMPACTION

Fecal Impaction

  1. Signs, symptoms, incidence, and diagnosis of fecal impaction in SCI include:
    • Loss of appetite and nausea, common upon admission to rehab facility
    • Abdominal distension and fecal masses (detected by auscultation and palpation)
    • Factitious diarrhea
    • Plain films of the abdomen show large amount of stool in the colon, air patterns in the intestines may be abnormal, and small bowel loops may be dilated

  2. Prevention and treatment of fecal impaction in SCI include:
    • Routine rectal evacuations, with suppositories or enemas, during first 3 or 4 consecutive days following admission to prevent or treat mild impaction in which there is nausea and/or appetite loss, but no vomiting or abdominal pain
    • Routine oral laxatives, particularly the bulk-forming types with polysaccharide or cellulose, and adequate hydration, to prevent fecal impaction in patients with chronic (decades or more) SCI. Hyperosmotic laxatives, such as milk of magnesia or lactulose, may be used if necessary.
    • Nasogastric suction to decompress the upper GI tract may be necessary in chronic SCI and fecal impaction, where the distal colon may be damaged from distention and chemical damage, and there is vomiting, abnormal bowel sounds, severe dehydration, and dilation of small bowel loops. Oral agents are not recommended in chronic SCI or impaction.
    • Fragmentation and extraction using lidocaine jelly is recommended if stool can be reached; spinal anesthesia is recommended if patient is prone to autonomic dysreflexia. Sodium enemas can be tried, but soap-suds enemas and suppositories should be avoided.
    • A colonoscopically directed lavage with a water-soluble contrast medium in a 20% to 50% solution may be necessary if the impaction is in the proximal colon.
    • Surgical decompression and, ultimately, colostomy, for patients with recurrent, severe fecal impactions, and/or bowel sores

  3. Complications of fecal impaction include:
    • Spontaneous colonic perforation, promotion of autonomic dysreflexia, and other life-threatening complications
    • Damaged colonic mucosal during disimpaction, which can cause hemorrhoids and/or bacterial sepsis
    • Stercoral sores of the bowel, due to chronic fecal distension
    • Deleterious function of the GI tract, which commonly causes nausea

The Gastrointestinal Dysfunction site of the PoinTIS Spinal Cord Medicine site of the SCI Manual for Providers is based on information in Spinal Cord Injury: Medical Management and Rehabilitation, G.M. Yarkony, ed., Gaithersburg, MD, Aspen Publishers, 1994, except for information where other papers are cited.