Fact Sheet: Bowel Impaction

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Fact Sheet: Bowel Impaction

About Impaction and Severe Constipation:

Constipation is defined as delay or difficulty in defecation for three or more days. Constipation can also cause abdominal discomfort, decreased appetite, and stooling accidents. Severe constipation can result in an impaction. A fecal impaction is a large mass of dry, hard stool that collects in and blocks the rectum.  Fecal impaction is generally a complication of chronic constipation.  Watery stool from higher in the bowel may move around the mass and leak out, causing soiling or even diarrhea.

  • Individuals at risk for constipation include people who:

    • Have limited ability to move, such as bedridden patients or persons with severe diseases of the nervous system.

    • Take drugs that inhibit gut motility, including anticholinergics, antidiarrhea medications, methadone maintenance treatment for drug addiction and narcotic pain medication. 

    • Take medications like high doses of calcium for osteoporosis.

  • A diet of refined carbohydrates (white flour and sugar) with limited intake of natural fiber found in fresh vegetables, fruits, and whole grains can predispose to constipation.

  • On occasion there are circumstances such as pain from rectal fissures or even lack of toilet facilities nearby that can lead to stool withholding behavior.

  • Persons with limited communication skills, limited oral motor skills, and limited motor mobility are at higher risk of severe constipation and impaction.

Symptoms of Impaction:

  • Severe abdominal pain, high fever, and poor appetite may prompt hospital admission after which impaction is diagnosed and sometimes also urinary tract infection.

  • In people with chronic constipation, review of history may indicate that the individual had symptoms of sudden complete constipation with severe abdominal pain, frequent straining with passage of liquid stool, rectal bleeding, small semi-formed stools or small pellets, thin-pencil like stools and sudden watery diarrhea.


  • Treatment of impaction often requires repeated enemas and manual extraction followed by changes in diet, bowel habits, and medications to keep stool soft and regular.

  • Medications may be used to control constipation and to prevent a recurrence of fecal impaction.

    • Stool softeners may be recommended to help pass soft, formed stools.

    • Bulk fiber laxatives may be used to add fluid and bulk to the stool. 

  • Diet adjustments such as increasing fluid intake and also increasing fiber intake from whole-wheat grains, bran, and fresh fruits and vegetables may help soften and add bulk to the stool and promote normal bowel movements.

  • For individuals who have difficulty communicating and who require assistance with toileting, and who also have constipation, it is important to keep track of the frequency of bowel movements.

    • To prevent impaction, if the individual misses bowel movements for over three days then there may been a need for dietary adjustment or medication change. The physician should be notified.

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