Ask the Pharmacist – Impaction

Q. My son had diarrhea and vomiting and later was unable to urinate for more than 24 hours. I was worried he was very dehydrated and sent him to the hospital thinking they would hook him up to intravenous fluids. It turns out that he had a fecal impaction that was causing these symptoms. Can you help explain this to me?

A. Fecal impaction results from chronic constipation that is left untreated. The stool/feces/poop, or whatever name you give it, become very hard and get “stuck” in the rectum and backs up in the colon. This impaction may cause further abdominal pain, lower back pain, bloating, inability to pass stools, loss of appetite, fatigue, and eventually ulcers and a colon obstruction.

The blockage may allow small pebbles of stool or liquids to pass through but not much more. It may also cause vomiting since there is nowhere for the digested food to go. In dire situations, such as the one you described, the impacted stool can press on the bladder and prevent it from emptying.

Before it causes permanent damage, it is wise to seek the help from a health care practitioner to confirm the diagnosis and methods to remove the impaction. One of the ways this can be done is with the help of an enema and an extensive laxative protocol to help retrain the bowel to learn proper bowel habits. There is a chance you may need a manual removal of the impacted stool but this should only be done by trained healthcare practitioners.

Before you allow your body to get to that point, let’s go back to what led to the fecal impaction. The root cause of fecal impaction is constipation that has not been addressed. There are some people who are more prone to constipation and fecal impaction such as the elderly (slower metabolism, muscle weakening in digestive tract), the young (haven’t developed muscle strength in digestive tract yet), people who are not mobile (lack of physical movement), and those with neuropsychiatric conditions such as Parkinson’s disease, Alzheimer’s disease and dementia.

Here are a few questions to ask yourself to learn if you are constipated.

1. Do you have fewer than 3 bowel movements each week?
2. What is the consistency of your poop? Hard or dry or lumpy?
3. Is it painful to have a bowel movement?
4. Do you have pain in your abdominal area?
5. Do you get nauseated without other causes?
6. Do you feel like you still have poop left inside of you after you finished having a bowel movement?

If you have answered yes to some of these questions, you may already be constipated. Now is the time to take action to prevent chronic constipation and eventually a fecal impaction. This is totally preventable! Take a look at the various lifestyle choices that can lead to constipation;

Lack of dietary fibre: Fibre adds bulk and shape to our poop and allows it to move more readily through the colon. Eating plenty of fruits, vegetables, legumes and whole grains is a great way to add fibre to your diet. The daily fibre recommendations for adults is;

Age 50 or younger Age 51 or older
Men 38 grams 30 grams
Women 25 grams 21 grams

Lack of water:  Drinking plenty of water, ideally without caffeine, in your diet is important to keep the stools soft and also helps to decrease the risk of bloating and gas that is common with fibre rich foods.

Lack of exercise:  Movement through exercise helps the muscles associated with your gastrointestinal tract to work more efficiently. Try to be active most days of the week.

Excess cheese and/or milk:  Dairy products consumed in excessively large quantities may cause constipation. This is by no means a reason to avoid dairy but rather to consume it in moderate amounts.

Stress:  Stress appears to tighten up the muscles in our body and the muscles in our GI tract is no exception. Though we may not be able to rid of the stress in our lives, we may be able to learn how to manage it better.

Resisting urge to poop/excrete:  Resisting the urge to have a bowel movement can trend towards bad bowel habits.

Change in routine: e.g. travelling A change in routine can definitely affect your body and occasionally we may need a little help to prevent constipation. Often when we travel, we may not get the right amount of fibre or exercise that keeps us regular.

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Take a look at the Bristol Stool Chart and see how that compares to your own stools. You want your stools to look more like the middle of the chart and ideally a Type 4.

Stay tuned for the best ways to achieve a high fibre diet. We’ll let you in a little secret… it does not include pop, chips, ice cream or processed foods. In the meantime, if you think you are constipated and require some help with getting some more appropriate bowel movements, contact your pharmacist.