Fecal impaction (also referred to as impacted bowel) is a serious medical condition that results when a large, dry and hardened mass of stool becomes lodged in the colon or rectum and cannot be expelled naturally. In some cases, you may have also lost the ability to sense or respond to the urge to defecate. Fecal impaction is different from typical constipation, which is more easily treated with dietary changes and over-the-counter products, as it represents a more advanced and potentially serious type of obstruction. When the stool becomes so hardened that it cannot be passed without medical intervention, that is when fecal impaction occurs.

You may feel extreme discomfort and rectal pain. With no treatment, there could also be damage to rectum, bowel perforation or even systemic infection. Fecal impaction can often occur in older adults, especially those with chronic constipation or limited mobility, or those taking medications that reduce the likelihood of spontaneous bowel movements or slow intestinal transit.

Fecal impaction usually occurs as a result of unnoticed or chronic constipation. When stool sits in the colon too long, the colon merely continues to take water out of it, making the stool harder and drier. Eventually, the stool can become so hard and large that it cannot pass through the rectum. This is fecal impaction.

Common causes include:

• Chronic Constipation: This is the most frequently encountered cause of fecal impaction. The underlying reasons are usually poor eating habits, dehydration and straining to have bowel movements (voluntarily or involuntarily) in the first degree. 
• Low-Fiber Diet: A diet low in fiber decreases stool bulk and should be less frequent than the normal of having three bowel movements a day. The low-risk factor is that the body has more time to remove waste from the body and slow down intestinal movement.
• Inadequate Fluid Intake: Dehydration leads to dry, hard stools and increases the likelihood of a stool being impacted.
• Lack of Activity: Physical inactivity reduces intestinal motility. It is typical in older adults, especially those who are bedridden. 
• Medications: Medications can also slow bowel function. These are opiates, anticholinergic drugs, any antacids that contain either aluminum or calcium, medications with iron, or some antidepressants.
• Neurological Problems: Conditions such as Parkinson’s disease, multiple sclerosis, or spinal cord injuries can prevent nerve signals from reaching the colon and slow down or stop bowel motility.
• Colon or Rectal Anomalies: Physical obstructions, including strictures, rectal prolapse, or cancers, can obstruct the passage of stool and can result in impaction. 
• Not Paying Attention to the Urge to Defecate: Regularly ignoring your natural urge to defecate can diminish the sensitivity in your rectum over time and can cause the accumulation of stool. 
• Mental Health Disorders: Many mental health disorders, such as depressive disorders or eating disorders (especially anorexia nervosa), can negatively affect a person’s diet, fluid intake or bowel habits and increase the likelihood of impaction.
• Too Much Laxative Use: Using too many laxatives can disrupt the way that the body signals when it is necessary to have a bowel movement. Over time, this can ultimately lead to dependence and fecal impaction.
• Poor Bathroom Behaviors: Regularly delaying bowel movements—due to lack of access to a restroom, discomfort with public toilets or unfamiliar environments—can lead to stool buildup, eventually resulting in fecal impaction.

Fecal impaction is usually not sudden and often develops because of chronic constipation or untreated difficulties with pooping. When feces remain in the colon for a longer time, the body continues to absorb water, which makes feces dry, hard, and compacted. Eventually, the feces will create a mass that the intestines can no longer move on their own.

Anyone can become impacted, but there are factors associated with a higher risk of fecal impaction:

• Older adults (especially those in nursing homes or long-term care)
• Patients who are bedridden or immobilized, resulting in decreased physical activity
• Patients who use opioids for treatment of chronic pain
• People with impaired cognitive function or dementia—they do not recognize or report bowel-related problems
• Post-surgical patients taking pain-relieving medication that slows bowel activity
• Individuals eating a low-fiber diet
• Not drinking enough water to keep feces soft and easier to pass

The longer someone is constipated, the more likely they are to develop fecal impaction. In some cases, what appears to be diarrhea may be overflow incontinence or liquid stool leaking around a hardened mass of impacted stool. This is important to understand so the condition can not only be diagnosed but treated promptly.

Fecal impaction can occur with a wide variety of symptoms, many of which can be confused with severe constipation; however, some are specific indicators for fecal impaction and other bowel problems.

Symptoms can range from mild discomfort to very severe life-altering conditions.

Common symptoms include:

• Lower Abdominal Pain or Cramping: Pain is typically located in the lower abdomen and can be dull and mild to severe and sharp. 
• Inability to Pass Stool: Even though there may be repeated urges and attempts, people can be completely unable to pass stool. 
• Straining While Attempting a Bowel Movement: Straining with no stool passed, or if only a little stool gets expelled indicates fecal impaction. 
• Hard, Dry Stools: Regardless of whether any stool passes, it will be small, pellet-like, and extremely hard.
• Bloating and Abdominal Distension: The abdomen can look visibly enlarged and feel tight as a result of gas or stool that has built up. 
• Nausea and Vomiting: More severe cases can present with nausea and vomiting, if the obstruction affects the upper gastrointestinal system. 
• Rectal Discomfort or Pressure: Feeling of fullness or sensation of something stuck in the rectum. 
• Leaking of Liquid Stool and/or Mucus: This may be attributed to diarrhea, when in fact it is overflow incontinence when liquid stool is no longer able to be contained due to the affected mass in the rectum. 
• Loss of Appetite: Instead of being hungry, the affected person may experience abdominal discomfort and bloating, and as a result may not feel like eating. 
• Fever (in severe cases): A fever may indicate the presence of infection (or inflammation) possible as a result of prolonged stool retention. 
• Confusion or Agitation in Aged Individuals: In older patients, the manifestations of stool impaction may be compensated for by other medical symptoms; may report sudden change in their mental status and/or behavior. 
• Rapid Heart Rate (Tachycardia): A high heart rate may occur when the obstruction is severe; as a result of pain, or refractory infection, or dehydration. 
• Lower Back Pain: The impacted mass in the rectum can compress the sacral nerves, resulting in referred pain in the lower back. 
• Urinary Symptoms: The impacted mass may put pressure on the bladder or urinary tract, and can contribute to increased urinary frequency and urgency, this can also contribute to overflow or incontinence on occasion.

A diagnosis of fecal impaction usually begins with the patient’s medical history and a physical exam. The provider will ask about bowel habits, diet, fluid intake, current medications, and prior history of constipation with or without impaction.

Your provider may take these diagnostic steps:

1. Digital Rectal Examination (DRE): One of the first, direct, and accurate steps to diagnose fecal impaction is to perform a DRE. The physician places a gloved, lubricated finger into the rectum to feel for hard, impacted stool. 
2. Abdominal X-ray: Abdominal X-ray assists in visualizing the area of colon and rectum to determine if there are large amounts of retained stool, and the area of the impacted stool. 
3. CT Scan or Abdominal Ultrasound: In more complicated or less clear cases, a CT scan or abdominal ultrasound may be helpful to ascertain the extent of impaction, look for complications, or consider other causes of abdominal symptoms. 
4. Colonoscopy or Sigmoidoscopy: Colonoscopy or sigmoidoscopy may be warranted in patients with recurrent fecal impaction or if structural problems (tumors or strictures) are suspected.

The treatment of fecal impaction depends on the severity of the condition and the patient’s overall health, with the primary intention of eliminating the impacted stool, relieving symptoms, and returning bowel function to normal.

• Manual Disimpaction: Usually, the first step that is taken in the clinic. The healthcare provider inserts a lubricated finger into the rectum to mechanically disimpact the stool and then manually remove it. This is usually performed using lubrication and may require local anesthesia or sedation depending on if significant rectal pressure is produced.
• Enemas: Enemas can be used to soften and lubricate stool, and ultimately promote drainage. Enemas can include:
  • Mineral oil enemas that can help soften stool.
  • Saline enemas that can stimulate bowel contractions. 
  • Phosphate enemas can be somewhat dangerous when used by elderly patients or patients with underlying kidney conditions.
• Laxatives: After partially disimpacting with finger or an enema, laxatives can assist with facilitating the complete clearance: 
  • Osmotic laxatives (e.g., polyethylene glycol, magnesium citrate) are meant to draw water into the intestines in order to soften stool.
  • Stimulant laxatives (e.g., senna, bisacodyl) to stimulate contractions of the bowel muscles. 
  • Generally, laxatives should never be used until it can be confirmed that a full obstruction does not exist.
• Suppositories: Rectal suppositories like bisacodyl or glycerin help soften stool and increase rectal contractions. They are useful in mild cases or when used with other treatments. 
• Hydration and IV Fluids: Patients who are dehydrated, especially the ones who vomit or can’t drink fluids, will receive IV fluids to help with hydration and pass softer stool. 
• Hospitalization:
  • Severe or complicated cases—those suffering with vomiting, risk of bowel perforation, or signs of systemic infection—should be hospitalized. 
  • Surgery is usually not required, but may be appropriate in: 
    • Cases that have failed conservative treatments.
    • Bowel perforation.
    • Significant rectal bleeding or other complications such as bowel necrosis.

Fecal impaction is a serious, non-lethal medical condition that is avoidable and often develops from chronic constipation and poor bowel habits. If not treated in a timely fashion, fecal impaction can lead to significant discomfort, complications, and the need for hospitalization. Recognizing early warning signs and risk factors are key to early diagnosis and successful intervention. Fecal impaction will typically be treated with a variety of interventions, including manual removal, enemas, laxatives and supportive care. The prevention of fecal impaction in the long-term relates to habitual lifestyle and dietary changes—this is even more crucial for the elderly, individuals in the hospital who are immobile, and individuals who are taking medications which cause constipation.

Establishing regular bowel habits—along with adequate fluid intake, dietary fiber and light physical activity—can help prevent fecal impaction by supporting effective colon emptying. If you, a family member, or loved one has chronic constipation, or symptoms suggestive of fecal impaction, talk to a healthcare provider sooner than later to help avoid very serious complications. Your gut health depends on it, and small steps toward improving your health can make a difference.

• Setya, A., Mathew, G., & Cagir, B. (2023, July 4). Fecal impaction. In StatPearls. Treasure Island (FL): StatPearls Publishing. 
• Medical News Today. (2023).Fecal impaction: Symptoms, causes, and treatment. Medical News Today.  MedlinePlus. (2024). Fecal impaction. National Library of Medicine. Retrieved from 
• ResearchGate (Morgan et al.). (2007). Management and prevention of fecal impaction. Digestive and Liver Disease.  Setya, A., Mathew, G., & Cagir, B. (2023, July 4). Fecal impaction. In StatPearls. Treasure Island (FL): StatPearls Publishing. 
• Wikipedia contributors. (2025, May). Fecal impaction. In Wikipedia, the Free Encyclopedia. Retrieved June 15, 2025,