Fecal loading

Fecal loading, also called fecal impaction, refers to the accumulation of solid feces in the rectum and the large bowel.

Epidemiology

Fecal loading is common, and usually seen among elderly, bedridden patients or incapacitated people, but many risk factors are recognized including chronic constipation, sedentary lifestyle, low fiber diet, medication intake, e.g. opioids.

Clinical presentation

Patients may complaint from :

• abdominal tenderness
• meteorism
• proctalgia
• infrequent defecation of solid stool

Radiographic features

Plain radiographs

Fecal loading may be seen as a speckled low density soft tissue mass, within a distended large bowel.

US

Distension of the small bowel loops may be observed.

Complications

Untreated fecal loading may lead to an increase in large bowel pressure with possible bowel obstruction or stercoral perforation.

It may also exert pressure on adjacent organs and vessels with a reported case of bilateral pelvic venous thrombosis .

Treatment

Fecal loading removal may be performed manually, with water irrigation, enema, laxatives or with rectal cleansing under sigmoidoscopy.

Physical activity, fiber-rich diet, sufficient fluid intake and prokinetic drugs are prescribed to stimulate transit and to change the stool consistency, thus preventing recurrence.