How do you Know When Fecal Impaction Has Cleared? 6 Signs.
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Summary: What you need to know.
Here is how you know when fecal impaction has cleared:
- The passage of a large amount of stool at once: is the most important sign.
- The immediate relief of abdominal distension and bloating after the passage of stool.
- The improvement in abdominal pain or discomfort.
- The disappearance of soiling accidents.
- The improvement of nausea and vomiting.
- The disappearance of the constant urge to poop.
Sometimes, the above signs are not sufficient to confirm the clearance of stool impaction. An abdominal radiograph may be required by your doctor to confirm the clearance of stool impaction.
1- The passage of a large amount of stool.
The first and the most important sign of clearance of stool impaction is the passage of stool.
Fecal impaction is the presence of a large mass of stool (usually hard). It is often in the rectum or sigmoid colon (reference).
Clearance of the impacted mass occurs either spontaneously or after the evacuation of the impacted mass by your health care provider.
The amount of stool should be large. This is important to distinguish the cleared fecal impaction from:
- False (superiors)diarrhea: because of leakage of liquid stool from around the impacted mass.
- Partial (incomplete) disimpaction: sometimes a small to moderate amount of stool passes due to partial breakdown of the impacted mass.
A good sign is of complete clearance is having a second bowel movement within hours to a day. A second bowel movement confirms that the clearance is now complete.
2- The relief of abdominal distension and bloating.
Fecal impaction causes progressive distension and bloating. This is because of the mechanical obstruction caused by the hard poop mass.
The patient with fecal impaction usually experiences immediate relief of sense of distension.
This immediate relief of distension together with the passage of a large stool amount are the 2 most important signs of clearance of fecal impaction.
but, this sign is not as important as the passage of a large amount of poop. This is because:
- Some fecal impaction sufferers originally don’t have distension and bloating.
- Patients with neurological diseases and seniors may not have the sense of distension.
3- The disappearance of the constant urge to poop.
A large subset of patients with fecal impaction complains from the persistent urge to poop. However, they are unable to poop due to mechanical obstruction of the rectum or sigmoid by the impacted stool mass.
The disappearance of the constant urge to poop is a good sign of clearance of fecal impaction.
Related: the urge to poop but only mucus comes out.
4- The improvement of abdominal pain.
Abdominal pain or discomfort often improves after the clearance of impacted stool.
The persistence of abdominal pain or discomfort may indicate that the disimpaction is partial or not complete.
But you should note that using large doses of laxatives as PEG (MiraLax) can cause abdominal discomfort, nausea, and bloating even with complete decimation (Learn more about the side effects of MiraLax).
So, abdominal pain can continue after clearance of fecal impaction (as a side effect of laxative use).
So, the best way to know when fecal impaction is cleared is to check for all the signs enlisted in this article. The more signs you find, the more likely the stool impaction has been cleared.
Taking into consideration that the most important sign is the passage of a large amount of stool.
5- No more soiling accidents.
Soiling accidents are the leakage of liquid stool without defecation (stool incontinence).
Soiling accidents occur with fecal impaction because of two factors (reference):
- Accumulation of liquid stool above the impacted mass. Which then leaks downwards from around the mass.
- Relaxation of the rectum and anal sphincter as a result of the presence of the hard poop mass in the anorectal area.
The disappearance of soiling is a sign of clearance of impaction and evacuation of the colon.
6- The relief of Nausea and vomiting.
Severe cases of fecal impaction may lead to signs of intestinal obstruction such as:
- Extreme abdominal distension.
- Persistent nausea.
- Occasional or persistent vomiting.
With the clearance of the impacted stool, Nausea and vomiting may improve or disappear.
However, we often use large doses of laxatives such as Polyetherele glycol (MiraLax) to help clearance of the impacted stool. MiraLax can cause worsening (rather than improving) nausea and vomiting.
So, it is not an essential sign of clearance of stool impaction.
7- Abdominal Radiograph may be necessary.
The impacted stool mass can be low in the rectum or high in the colon. sometimes, doctors we as doctors are unable to tell for sure if the impaction is cleared.
So, we may need an abdominal radiograph to make sure the fecal impaction is cleared.
The imaging can be:
- Plain abdominal radiograph (x-ray), better in the erect position.
- CT abdomen with oral and rectal contrast to visualize the site of impaction.
A comparison between the imaging before and after disimpaction is sometimes done.
The disappearance of the impacted stool mass and improvement of colon distension in the radiograph is a sure sign of clearance.
A final word.
- Impaction is common in seniors and patients with major diseases such as brain and spinal cord conditions.
- It is always recommended to seek professional help with fecal impaction if you are not a health care professional.
- Many signs of clearance of stool impaction may not be present in people with brain and spinal cord diseases affecting sensations of the gastrointestinal tract.
- We may need an abdominal radiograph in some cases to confirm the clearance of fecal impaction.