Faecal impaction with overflow
Faecal impaction or faecal loading occurs when the rectum, and often the lower colon, is full with hard or soft stool and the individual is unable to evacuate their bowel unaided.
It usually happens when there has been no adequate bowel movement for days, or weeks, and a large compacted mass of faeces builds up in the large bowel which cannot be passed.
Liquid, Bristol stool chart type 6-7 stool, can leak around the mass. This happens between bowel movements, causing soiling of loose stool on clothing called faecal overflow incontinence/spurious diarrhoea.
The leakage occurs with no awareness as the urge to defaecate has been lost as a result of the distended rectum. The loose stool is often very offensive and the smell lingers.
The large stool can be very painful and distressing to pass.
If the constipation is not treated effectively and the bowel is completely emptied, the problem is likely to reoccur.
The majority (98%) of faecal impaction occurs on the rectum but it can also occur in the colon (1.6%) and in the ileum (0.4%)
Clinical practice point. On examination of the abdomen it can be felt as hard lumps and, in severe cases, when the individual is supine.
Figure 4.8: Sites and frequency of faecal impaction in the colon and rectum.
The top illustration in Figure 4.9 below shows normal bowel function with the stool in the rectum and no constipation and the lower illustration shows impacted faecal mass pressing on the urethra and bladder stretching the pelvic floor (rectal loading).
Figure 4.9: Comparison of normal bowel function with faecal impaction.
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