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Impaction
Description and Causes
Assessment of Impaction
Treatment of Impaction
Description and Causes
Five major factors can cause impaction:
- Opioid pain medications.
- Inactivity
over a long period.
- Changes in diet.
- Mental illness.
- Long-term use of laxatives.
Regular use of laxatives for constipation contributes most to the
development of constipation and impaction. Repeated use of laxatives in higher
and higher doses makes the colon less able to signal the need to have a bowel movement. (See the Constipation section for causes of constipation that can result in impaction.)
Patients with impaction may have symptoms similar to patients with
constipation, or they may have back pain (the impaction presses on sacral nerves) or bladder problems (the impaction presses on the ureters, bladder, or urethra). The patient's abdomen may become enlarged causing difficulty
breathing, rapid heartbeat, dizziness, and low blood pressure. Other symptoms
can include explosive diarrhea (as stool moves around the impaction), leaking
stool when coughing, nausea, vomiting, abdominal pain, and dehydration.
Patients who have an impaction may become very confused and disoriented with
rapid heartbeat, sweating, fever, and high or low blood pressure.
Assessment of Impaction
The doctor will ask questions similar to those in the Assessment of
Constipation section and do a physical examination to find out if the patient
has an impaction. The examination may also include x-rays of the abdomen
and/or chest, blood tests, and an electrocardiogram (a test that shows the
activity of the heart).
Treatment of Impaction
Impactions are usually treated by moistening and softening the stool with an enema. Enemas must be given very carefully as prescribed by the doctor since
too many enemas can damage the bowel. Some patients may need to have stool
manually removed from the rectum after it is softened. Glycerin suppositories
may also be prescribed. Laxatives that stimulate the bowel and cause cramping
must be avoided since they can damage the bowel even more.
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