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Thursday, July 27, 2023

Fecal Impaction Off The Grid

 Original Article


A couple of my recent articles have discussed bowel irregularities, namely constipation, as a result of exclusively eating long shelf-life foods meant for off-grid scenarios. Failure to take precautions against constipation can lead to a decreased quality of life and, as well, work efficiency for group members in uncertain times. The end result of neglecting slow intestinal motility may be a condition known as fecal impaction.

Fecal impaction is defined as a hard mass of feces in the rectum which a person is unable to expel. It’s usually the result of severe constipation. An inability to pass bowel movements causes feces to back up into the colon, where water is absorbed from the bowels. The stool becomes very clay-like and accumulates.


Fecal impaction occurs most commonly in:

  • The elderly. Fecal impaction rates over the course of a year approached 47.3% in one study of nursing home patients.
  • People who are bedridden or otherwise mobility-impaired.
  • People with nerve disorders like Alzheimer’s disease, Parkinson’s, or spinal cord injury.
  • Children.
  • Those taking certain medicines.


There are many medications that can cause constipation and may lead to fecal impaction. They  include:

  • Opioid pain relievers
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Antihistamines
  • Tricyclic antidepressants
  • Urinary incontinence medications
  • Iron supplements
  • Blood pressure medications
  • Anti-nausea medications

An individual’s response to a certain drug is, well, individual, so certain people experience this more than others.


How can you identify the person with a fecal impaction in survival scenarios, where food may be scarce? Many survival foods are low in fiber and constipation will be rampant throughout your group.

Symptoms of a fecal impaction can include:

  • Abdominal pain.
  • Swollen abdomen.
  • Loss of appetite.
  • A sensation of constantly being full.
  • Frequent urination from pressure on the bladder.
  • Fatigue and listlessness.
  • Bleeding from the rectum.

In severe cases, the patient becomes nauseous. Dehydration is common, and older sufferers become confused and have other signs of impaired mental status.

Surprisingly, you may note the patient has diarrhea. This is because watery stool is making its way around the clay-like impaction.

Making the diagnosis requiring inserting a gloved finger (with lubrication) into the rectum. The hardened stool should be readily apparent on exam.


Once the diagnosis is made, it’s up to the medic to relieve the blockage. This may be best accomplished by the use of laxatives and enemas. Injecting fluid through the anal route may loosen the impaction. Push fluids orally to improve hydration status and enforce a routine of evacuating bowels at regular intervals.

If all else fails, the off-grid medic may have to perform physical “digital disimpaction“. For this procedure, lubricate a single finger of a gloved hand and insert into the rectum. The clay-like stool is broken up and removed in pieces as gently as possible. In normal times, please be sure to leave this to experienced medical professionals.

Don’t be surprised if some bleeding occurs as a result of your manipulation as the lining of the rectum may be traumatized. This may occur even if digital disimpaction is not performed due to the density of the stool. Soreness in the area may be expected afterwards, but most patients feel better once the procedure is done.


In most cases, fecal impaction is preventable with some lifestyle changes:

  • Stay hydrated.
  • Increase fiber intake.
  • Adjust constipation-causing medications if possible.
  • Be active (regular walks are acceptable).

It’s unlikely that you’ll be confronted with a life-threatening case of fecal impaction, but failure to diagnose and treat chronic constipation can be problematic for the off-grid medic. Be sure to monitor diet and encourage group members to report changes in bowel habits.

Joe Alton MD

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