Coprostasis: Causes, Symptoms & Treatment

Coprostasis is the accumulation or buildup of stool in the large intestine. It is therefore alternatively called fecal impaction or fecal impaction. The English terms are coprostasis and fecal impaction, respectively.

What is coprostasis?

Coprostasis is not a disease in the strict sense. Rather, as a symptom, it represents a serious disorder of final digestion and thus a serious health problem. The stool present in the rectum is not transported further in affected patients and accumulates mainly in the last area of the rectum, the rectum. This is followed by a steady dehydration of the stool, which causes the feces to thicken and solidify. The result is water-depleted, hardened fecal balls, medically known as skybala. These bound balls of feces gradually close off the bowel and cause the affected person to be able to empty his or her bowels only in fragments. If the ball of feces becomes completely stuck, similar to a plug, bowel emptying is no longer possible even under pressure. Dehydration of the intestinal contents continues and fecal stones are formed. These stone-like formations consist of massive and heavily thickened stool. They are surrounded by a layer of mucus and dried stool debris.

Causes

Coprostasis usually forms from chronic constipation. The civilization disease constipation, commonly known as constipation, has a wide variety of causes. For the most part, a dry diet low in fiber and a concomitant lack of exercise (including bed rest and immobilization) are the triggers for constipation. In addition, intestinal diseases such as abscesses, adhesions, hemorrhoids or even tumors can be the reason for constipation. But nerve diseases such as Parkinson’s or multiple sclerosis, muscle diseases and hormonal fluctuations during pregnancy are also possible causes of constipation. Finally, even side effects of medications should not be underestimated. Among other things, antidepressants, opiates and antiepileptics repeatedly lead to unwanted constipation. In older patients, the cause of coprostasis is often insufficient fluid intake. In addition, with increasing age, the rectal muscles become slack and intestinal peristalsis is often disturbed. Coprostasis can also occur due to acquired or congenital megacolon (dilation of the colon) and after intestinal obstruction.

Symptoms, complaints, and signs

Coprostasis is generally accompanied by severe pain in the lower abdomen. They occur mostly on the right side and intensify as soon as defecation reflexes occur. Especially in a sitting position, fecal balls and fecal stones lead to pain during this voiding reflex. Patients commonly complain of a pronounced meteorism. This accumulation of intestinal gases causes intense and thus unpleasant flatulence. Less frequently, however, nausea and vomiting occur in connection with coprostasis. However, in conjunction with the right-sided pain, these are often cause for confusion with appendicitis (appendicitis). An appropriate clarification with a specialist should be made. Particular caution is required if feigned diarrhea occurs, in which large intestine secretions pass the fecal impaction to the outside. It may be followed by fecal incontinence, through which retention of stool and voluntary defecation are no longer possible.

Diagnosis and course

A diagnosis can only be made by a specialist. This can feel the hardened fecal balls and fecal stones in the best case already through the exposed abdominal wall, which are called hereafter coprom or also stercoroma. A clear finding, however, provides only an X-ray of the abdominal region.

Complications

Significant complications can occur with coprostasis. Due to the stasis of feces in the intestine, there is a risk of intestinal infection, and so-called transmigratory peritonitis may also occur. Initially, however, diarrhea and nausea occur, often accompanied by constipation and other intestinal symptoms. In the further course, untreated coprostasis can cause intestinal obstruction, which is often life-threatening for the patient. In less severe cases, coprostasis leads to urinary incontinence and later to fecal incontinence.In the advanced stage, coprostasis often leads to severe poisoning conditions and infections in the intestine. This initially results in circulatory problems, and later life-threatening organ dysfunction and further complications occur. These include: Proctalgia, intestinal obstruction and rupture of the appendix, depending on the underlying condition and the timing of treatment. Fecal stasis also increases the risk of fecal stones, which prevent complete emptying of the bowel, thereby promoting a variety of gastrointestinal disorders such as infection and constipation. If coprostasis is treated early, long-term complications usually do not occur. Laxative preparations can cause short-term deficiencies, dehydration, and physical fatigue, while surgical procedures carry the risk of injury to the bowel.

When should you see a doctor?

In case of strong discomfort in the lower abdomen, even if it occurs on the right side, most people think of a harmless symptomatology, which you may possibly associate with a certainly only temporary stool problem (constipation). However, these complaints are usually not harmless abdominal pain and should therefore at least be discussed with a doctor, who can then determine any further examinations that may be necessary after an initial diagnosis. If the all-clear can then be given, there is at least a reassuring clarity. If the pain occurs particularly when sitting or if a pronounced meteorism (accumulation of intestinal gases) is noticed, a specialist should be consulted immediately so that a differentiated diagnosis can be made on the basis of special intestinal examinations. The frequent parallel occurrence of intense flatulence underpins the urgency of a medical consultation. As with appendicitis (inflammation of the appendix), right-sided lower abdominal complaints may be accompanied by vomiting and nausea. An accurate differentiation between coprostasis and appendicitis should be made immediately by a specialist. If colonic secretions leak out or there is even fecal incontinence, the highest urgency is required for a visit to the doctor.

Treatment and therapy

The treatment of coprostasis should also be left to the specialist. Self-therapy with laxatives or home remedies is not recommended for the most severe form of constipation, because both an intestinal obstruction (medically ileus) and an intestinal infection, peritonitis and a so-called autointoxication can be the result. Autointoxication is a state of poisoning that results from bacterial invasion. Decomposition substances of the intestinal contents enter the bloodstream and cause fever, headache, fatigue and a weakening of the immune system. Therefore, especially the elderly, children and people with a weakened immune system should seek help immediately in case of coprostasis. Treatment of coprostasis depends on the severity and condition of the patient. Mild cases are treated with enemas and controlled intake of laxatives. Oral administration of a PEG solution followed by orthograde colonic irrigation is common. In more severe cases, digital stool evacuation is performed. This involves manual removal of the fecal plug by the specialist followed by a cleansing enema. Stool evacuation is usually painful for the affected person. Surgical intervention and the use of painkillers are resorted to only in exceptional cases. To prevent coprostasis from becoming chronic, the formation of new fecal balls must be stopped after the bowel has been completely emptied, and the consistency of the stool must be regulated. In children, stool training has proven effective in this regard.

Outlook and prognosis

In most cases of coprostasis, there is severe pain in the lower abdomen. The pain is usually intensified when the patient is sitting. In addition to the pain, the patient also accumulates intestinal gas, which can lead to uncomfortable feelings of pressure in the abdomen and unpleasant odors. Coprostasis can be relatively well diagnosed by a doctor with the help of an X-ray. In addition, the doctor can also palpate the presence of the fecal pads by hand. If the symptom is not treated, it can lead to a life-threatening intestinal obstruction. In the worst case, this can also lead to incontinence. In addition, there are several infections and inflammations in the intestine, which lead to severe pain. In most cases, treatment is carried out with medication.If this is started early, there are no further complaints or complications. Only in severe cases a surgical intervention is necessary, during which a cleansing of the intestine is performed. However, coprostasis may reoccur after treatment and thus is not completely eliminated.

Prevention

Otherwise, the most common preventive measures include adequate fluid intake and a high-fiber diet with grains, vegetables, and legumes. In addition, active exercise and weight loss for those who are overweight also promote bowel function. On the other hand, if you are prone to constipation and coprostasis, mild colonic irrigation is recommended. They loosen hardened areas and keep the intestinal walls supple. In children and patients with circulatory problems, a family doctor or specialist should be consulted before use as a precaution. Long-term use of laxatives is strongly discouraged. Despite apparent success, laxatives may promote coprostasis.

Follow-up care

In the case of coprostasis, there are usually very few, if any, special measures of aftercare available to the affected person. First and foremost, the disease must be detected and treated very quickly. Of course, the reason for the coprostasis should also be avoided, whereby the disease can have various causes. Therefore, causal treatment must also be carried out so that the disease can be completely cured. Most of the affected people depend on taking laxatives. Care must be taken to use the correct dosage so that poisoning does not occur. However, if the symptoms do not subside with the conservative methods, a doctor must be consulted again to prevent complete obstruction of the bowel. In some cases, surgical intervention may be necessary to alleviate the symptoms. After such an operation, bed rest must be observed in any case. At the same time, only light food should be taken so as not to strain the intestines. The food can then be normalized again over time. Possibly, coprostasis can lead to a reduced life expectancy of the affected person.

What you can do yourself

There are good self-treatment options against the congestion of feces in the colon. In principle, however, it should be noted that the therapy should be carried out under the supervision of a specialist. The uncontrolled use of home remedies and laxatives may result in more serious diseases such as obstruction or infection of the intestine, peritonitis or poisoning by invading bacteria. Those suffering from coprostasis should increase their intake of liquid foods and foods rich in fiber, such as grains, vegetables and legumes. Laxative foods such as sauerkraut, pineapple and sour milk are also advised. In acute cases, it helps to drink plenty of water. Taking a tablespoon of olive oil before breakfast also significantly increases the lubricity of hard stools. Plenty of exercise keeps the bowel active, strengthens the rectal muscles and prevents the formation of fecal balls or fecal columns. Daily abdominal massages are also an option, as they improve the shape, position, and tone of the muscles of the digestive system. If you are prone to coprostasis, regular light bowel irrigation is recommended. This loosens hardened areas and keeps the intestinal walls supple. Under no circumstances should laxatives be used permanently. Although these preparations often provide short-term relief, they exacerbate coprostasis in the long term. In some circumstances, these agents even cause fecal stasis in the first place.