Fecal impaction is a large mass of hard stool stuck in the rectum or colon that the patient cannot pass. It is common in older adults, bedbound patients and people taking opioids, and it needs removal and a plan to prevent it from coming back.
Key symptoms
- No bowel movement for several days with straining
- Watery stool leaking around the hard mass (overflow)
- Abdominal pain, bloating and loss of appetite
- Confusion or agitation in older adults
What you find on exam
- Distended, tender abdomen with a palpable stool mass
- Rectal exam finding hard stool in the rectum
- Vital signs and hydration status
- Check for urinary retention from pressure on the bladder
Tests
- Usually a clinical diagnosis by rectal exam
- Abdominal X-ray if the impaction is higher up or obstruction is suspected
- Electrolytes, calcium, glucose and thyroid tests to look for causes
- Review medicines such as opioids and anticholinergics
Treatment basics
- Manual disimpaction of the rectum with lubrication
- Enema with warm water or mineral oil, or a glycerin or bisacodyl suppository
- Oral polyethylene glycol once the rectum is cleared
- Prevent recurrence: fluids, fiber, activity and a scheduled bowel regimen
Red flags
- Vomiting with severe distension, suggesting bowel obstruction
- Fever, severe pain or rectal bleeding
- Slow heart rate or fainting during disimpaction
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Sources: NCSBN 2026 NCLEX-RN Test Plan; Open RN, Nursing Fundamentals 2e; NCCPA PANCE Content Blueprint. Written by Making Synapses. Making Synapses is not affiliated with these organizations.