Fecal stones are not only unpleasant for those who suffer from them, but also painful. Sometimes they can even become life-threatening. They are also not as rare as is commonly believed.
What is fecal stones?
A fecal stone (coprolite) is a usually round ball of feces about the size of a cherry pit. Quite common, sheep droppings – as they are popularly known – are the same color as the rest of the droppings, but are heavily hardened. Surrounding the hard layer are several layers of mucus and dried intestinal contents. Fecal stones settle in blind-ended intestinal segments and curvatures in the colon, diverticula (protrusions of the intestinal wall), and rectum. In most cases, they pass on their own with bowel movements. However, they become dangerous when they cause diseases such as intestinal obstruction or a perforation into the abdominal cavity with subsequent peritonitis. Fecal stones usually occur in connection with chronic constipation and are then located in the rectum, where they block the intestinal passage and only allow thin-bodied stool to pass. This gives the impression that the patient is suffering from diarrhea (paradoxical diarrhea). If the fecal balls go away on their own, they often cause intestinal irritation and pain.
Causes
Stool thickens into a fecal stone when it moves too slowly through the intestine because of insufficient intestinal peristalsis, and then too much fluid is removed from it. This is usually the case in people with irregular and chronic constipation. Other causes of fecal stones include irritable bowel syndrome, colon cancer, and normal metabolic deposits in the coils of the intestine. Patients with constipation usually do not consume enough fluids or have to take sedating drugs, which of course also have a calming effect on intestinal peristalsis. In addition, they often eat a diet low in fiber, high in fat and sugar, so that not enough stool volume can be built up. Long-term abuse of laxatives and, in diabetics, impaired conduction due to diabetic polyneuropathy can also lead to the formation of fecal stones.
Symptoms, complaints, and signs
Fecal stones can interfere with the transport of feces through the intestine in such a way that they cause stabbing colicky pain as the contents of the intestine pass by. If they have lodged in diverticula, they sometimes cause diverticulitis: the permanent pressure of the feces on the intestinal wall causes ulcers in the intestinal mucosa. If the stone breaks through the intestinal wall, it can cause peritonitis. If diverticulitis also spreads to other areas of the intestine, intestinal fistulas and abscesses are often the result. Because many fecal stones are so hidden that they cause little discomfort, they are sometimes only discovered during intestinal surgery. If they are located in the rectum, they can be palpated manually during a normal bowel examination. If they protrude into the cavity of the intestine, they can be detected with the help of an endoscopy. Fecal stones are also usually clearly visible on X-ray images. Ultrasound diagnosis, on the other hand, is not as reliable: the bright areas on the image may also indicate gas present in the intestine. If fecal stones interfere with the normal intestinal passage of feces, they often cause stabbing pain in the abdomen. If they are not removed or come off on their own, they can cause the life-threatening intestinal obstruction. If they cause tears on the intestinal mucosa, inflammation of the intestinal mucosa can occur and – if they break through into the abdominal cavity – peritonitis (inflammation of the peritoneum).
Complications
Fecal stones can cause several complications. First, there is a risk of intestinal obstruction, which can subsequently lead to life-threatening complications such as intestinal perforation and sepsis. In addition, a fecal stone can lead to the development of fecal abscesses that require further treatment. In the short term, fecal stones can decrease well-being and cause gastrointestinal discomfort. If the digestive system is completely blocked, vomiting of feces may occur, resulting in throat infections. In extreme cases, this can develop into pneumonia, which in turn is associated with severe complications. Because of the severity of these complications, prompt therapy is advised. Treatment of fecal stones can result in various complaints.Frequently, the removal of a large fecal ball results in an anal fissure, for example, which can become inflamed and lead to the development of abscesses. In the medium term, laxatives can lead to mineral deficiency or dehydration, accompanied by fatigue and a general reduction in performance. In the case of intestinal lavage, the preparations used may cause irritation and other side effects. Rarely, the preparations used cause allergic reactions and trigger diarrhea, for example.
When should you go to the doctor?
A fecal stone will only prompt a trip to the doctor in some cases, as many fecal stones are very small and very hidden. Sometimes they cause no discomfort at all, except that they may cause pain when they pass. In addition, small specimens often go unnoticed. However, if a coprolite is noticed by the affected person, a visit to the doctor is advised. The outgoing or existing fecal stone of sufficient size manifests itself, for example, with colicky pain, by severe pain during defecation, a persistent constipation or by a miserere. Sometimes it can also be palpated through the abdominal wall, provided it is large enough and located in an appropriate place in the intestine. If the fecal stone is removed, it is necessary to see a doctor to find out the possible causes. Metabolic diseases or nutrition can often be the reason. A family doctor can be a first port of call. A proctologist may be necessary regarding removal of fecal stones and examination of the bowel. If symptoms indicate a coprolite still inside, a quick medical examination is in order. After all, such a condition carries the possibility of life-threatening complications and sometimes severely limits the sufferer because the entire digestive system may be disrupted.
Treatment and therapy
In the presence of intestinal obstruction (ileus), there is a danger to life. It must be eliminated as soon as possible. Diverticulitis and breakthrough of the fecal stone into the lower abdominal cavity must also be treated as soon as possible. Often, the fecal ball is surgically removed. Surgical intervention is also necessary for fecal deposits located in the upper intestinal tract. Stones deposited in the rectum can be cleared out manually by the specialist or a specially trained nurse or dissolved by means of several enemas. Removal is usually performed after two failed attempts to soften the fecal ball The intestinal wall is gently stimulated with circular movements so that the ball loosens up and can be retrieved with iso-osmular drinking solution. Even if the patient feels great relief afterwards, the evacuation is usually very painful and is perceived as unpleasant. Fecal stones can also be flushed out with the help of colon hydrotherapy (colonic irrigation). Since much more water (about 35 liters) is introduced into the intestine than with an enema, additional encrustations caused by deposited indigestible food components and metabolic waste products can also be removed. As a rule, three intestinal lavages are necessary to clean the intestinal convolutions even in otherwise inaccessible places. Since several different water temperatures are used (up to 41 degrees and up to 21 degrees), intestinal peristalsis is also stimulated. In the case of fecal stones that occur in connection with intestinal diseases, the underlying disease is treated first. Elimination of constipation is done by administration of more or less strong laxatives, a change in diet.
Outlook and prognosis
In principle, it can be assumed that a fecal stone can be eliminated without and with medical help. This results in a favorable prognosis. However, the extent of treatment differs considerably. If there is no severe pain or bleeding, affected individuals can usually relieve discomfort via self-help measures. Adequate fluid intake and a diet rich in fiber counteract the problem. The situation is different in the case of complications such as intestinal obstruction. In this case, there is a danger to life. A doctor must be consulted immediately. Initially, medical personnel will attempt to correct the problem manually. If this does not succeed, surgery becomes necessary. The last procedure is always given in case of breakthrough into the lower abdomen. Patients must not ignore the typical symptoms in any case. In case of severe symptoms, consultation of a physician is inevitable. Those who delay the start of treatment for several days risk further inflammation.As a result, regular bowel movements are impossible. Sufferers with chronic constipation are considered susceptible to the fecal stone. They are advised to be more careful. Doctors advise regular bowel irrigation if susceptible. Diet and lifestyle habits should be changed permanently.
Prevention
Because fecal stones often occur in combination with (chronic) constipation and stool blockage, a high-fiber, low-sugar, low-fat diet is recommended. In addition, the affected person should consume at least 2.5 liters of fluid throughout the day and ensure daily bowel movements. From time to time, intestinal rehabilitation with certain herbs, psyllium or chlorella is recommended. Pro-biotic foods also help to rebuild the damaged intestinal flora. Colon massages (required for bedridden patients!) and certain exercises that stimulate peristalsis are also useful.
Aftercare
A fecal stone can be successfully removed. This often does not even require medical treatment. If there are no more symptoms, there are no reasons for scheduled follow-up examinations. This is because, unlike tumors, for which follow-up always occurs, no potentially life-threatening situation exists that requires early initiation of treatment. There is no extension of the disease in the form of metastases. Patients are informed of the causes of the first treated fecal stone. At the same time, they are also given behavioral tips for their everyday life if they are expected to become susceptible. However, the implementation of these tips is the responsibility of the patient. There is no medical control. Suitable preventive measures include a high-fiber and low-fat diet. Fluid intake should be at least two liters per day. People with chronic constipation and intestinal irritation are considered a risk group. For them, the permanent intake of certain sedative medications may be useful. This dissolves the fecal stones. If patients experience the typical symptoms again after an initial diagnosis, they should consult a doctor immediately. Depending on the extent of the blockage, life may be in danger. Appropriate acute procedures for detecting a fecal stone include radiographs and endoscopy.
Here’s what you can do yourself
Fecal stones can be self-treated by affected individuals only if they have not yet led to complications (bowel obstruction, miserere, etc.). In such cases, surgery or manual evacuation are unavoidable. Thus, small fecal stones and those that have formed in uncomplicated places can possibly be made to defecate by those affected by stimulating peristalsis. Exercise, a balanced diet and drinking enough fluids can help. In addition, the affected area – if known – can be massaged from the outside with some vigor. This may cause the fecal stone to break down or move on. An enema also helps. It is not necessary to add substances to the water in this case. However, water enemas (several hundred milliliters) only help if the fecal stone is in the last section of the intestine. Several enemas with alternating temperatures should be performed. Excessive use of (herbal) laxatives is not advised, because although diarrhea may occur, it will not be dissolved fecal stones. Thus, only dehydration and demineralization are risked. If pain, discomfort, bleeding, or other symptoms occur, discontinue all self-help measures and consult a physician.
