From the Guidelines
Fecal loading is typically characterized by abdominal distension, palpable fecal masses, and rectal fullness on digital examination, and can be confirmed with a plain abdominal X-ray to image the extent of fecal loading and exclude bowel obstruction. The signs of fecal loading indicate significant constipation with a large amount of stool accumulated in the colon. Patients may report abdominal discomfort, reduced appetite, and infrequent, difficult bowel movements. According to the ESMO clinical practice guidelines 1, if suspected clinically, corrected calcium levels and thyroid function should be checked, and more extensive investigation is warranted for those with severe symptoms, sudden changes in number and consistency of bowel movements, or blood in the stool.
Key Signs and Symptoms
- Abdominal distension
- Palpable fecal masses (especially in the left lower quadrant)
- Rectal fullness on digital examination
- Abdominal discomfort
- Reduced appetite
- Infrequent, difficult bowel movements
Diagnostic Approach
- Plain abdominal X-ray to image the extent of fecal loading and exclude bowel obstruction 1
- Check corrected calcium levels and thyroid function if suspected clinically 1
Management
- Treatment typically involves a bowel cleanout regimen
- Maintenance therapy with daily stool softeners, fiber supplements, increased fluid intake, and regular physical activity is recommended to prevent recurrence
- Addressing underlying factors such as slow colonic transit, inadequate fluid intake, or poor dietary fiber is essential for long-term management
- Patients with persistent symptoms despite treatment should be evaluated for underlying conditions like hypothyroidism, neurological disorders, or medication side effects 1
From the Research
Signs of Fecal Loading (Fecal Impaction)
The signs and symptoms of fecal impaction are varied and can be similar to those of constipation, making diagnosis challenging 2. Some common signs and symptoms include:
- Abdominal pain or discomfort
- Bloating or swelling of the abdomen
- Constipation or difficulty passing stools
- Nausea or vomiting
- Fever
- Abdominal tenderness or guarding
- Blood in the stool
- Rectal pain or discomfort
Diagnostic Evaluation
Evaluation with a careful history and physical examination, in conjunction with radiologic imaging, such as an acute abdominal series or computed tomography (CT), is imperative for diagnosing fecal impaction 3. Plain abdominal radiography may not be useful in diagnosing fecal impaction, as it does not significantly affect the management of patients presenting with constipation 4.
Laboratory Tests
Faecal calprotectin testing can be used to differentiate between inflammatory and non-inflammatory bowel diseases, but it is not directly related to the diagnosis of fecal impaction 5. However, it can help rule out other conditions that may be causing similar symptoms.
Complications
If left untreated, fecal impaction can lead to serious complications, such as bowel obstruction, stercoral ulcer, perforation, peritonitis, or cardiopulmonary collapse with hemodynamic instability 3, 6. Prompt identification and treatment are essential to minimize the risk of these complications.