Fecal Impaction

Faecal impaction is common in individuals that have been constipated for lengthy
periods of time. It defined as a condition in which the rectum or bowel is obstructed by
a dried out, somewhat large, hardened stool (Rowan-Legg, 2011).
The symptoms of impacted faeces are constipation, rectal discomfort, anorexia,
nausea, vomiting, abdominal pain, paradoxic diarrhea, faecal incontinence, urinary
frequency, urinary overflow and incontinence (Araghizadeh, 2005).

Fecal impaction occurs commonly in patients who have been experiencing constipation
for an extended period of time and have also been treating it with laxatives. The
chances of suffering from impacted feces increases if the course of laxatives are
stopped suddenly. This is because the digestive tract muscles forget how to properly
perform their function, due to an acquired dependency on the laxatives (Biggs and
Dery, 2006).

Certain drugs can increase the risk of fecal impaction, such as certain narcotic pain
relievers like anticholinergics that disturb interactions between muscles and nerves.
Diseases of the nervous system or the brain, that affect signal transmission to the
gastrointestinal tract can also cause fecal impaction. Again this inhibits the muscles of
the gut to perform correctly (De Lillo and Rose, 2000). Individuals that remain seated or
laying down for long periods of time, have an increased risk of fecal impaction, such as
hospital patients.

Diagnosis
Diagnosis is confirmed by a physical examination, digital examination, or an abdominal
ultrasound of the rectum and stomach from a medical professional. In some cases, a
barium enema will be used in conjunction with an X-ray to highlight problem areas. In
all cases a large hardened mass of stool will be revealed within the rectum. In some
cases, a colonoscopy will be used to investigate a sudden change in bowel behavior.
The colonoscopy will be searching for things such as rectal cancer (Whitehead et al,
1999).

Treatment
Treatment of fecal impaction is simply eradication of the stool causing the blockage.
This is commonly done by using an oil enema to soften and lubricate the stool in order
to help it pass. This is not enough to remove the blockage in most cases however, and a
medical professional is required to insert a finger or two into the rectum to manually
break up the stool. In some cases, a Barium enema has to be used to clear the blockage
(Araghizadeh, 2005).
Relation to case study
The neonate in the case study is suffering from a distended abdomen which is a
symptom of fecal impaction. This can be diagnosed or ruled from an examination of the
stomach and rectum of the neonate. Fecal Impaction can run in conjunction with
another disorder, so if a diagnosis is confirmed an underlying condition could be the
cause. Fecal impaction was ruled out because the neonate’s bowel movements were
normal after birth and remained normal for three months.