In a long-term survival situation or in a remote setting, it may be difficult to control what you’ll be eating on a regular basis.  If your family is not getting a lot of fiber their, you may find that constipation will be a common issue.

Constipation, if long-standing, may cause the formation of a large lump of clay-like stool that will not expel from the rectum even if the strongest pressure is exerted.  We refer to this condition as “fecal impaction”.

Those who are at most risk for fecal impaction:

• Eat diets low in fiber
• Overuse laxatives (and then suddenly stop)
• Are sedentary (bedridden or otherwise inactive)
• Use narcotic medications such as codeine or other opioids
• Have disease of the nervous system that affect intestinal motion
• Are dehydrated
• Are elderly

Common symptoms may include:

• Severe straining on the toilet
• Abdominal cramping and bloating
• Occasional passage of a very small or liquid stool
• Rectal bleeding
• Bladder pressure
• Lower back pain
• Light-headedness from straining

How to Diagnose Fecal Impaction

A rectal exam is necessary for the medic to make the diagnosis.  Using a glove and some lubricant, place the patient on their side with their legs bent towards the chest.  Carefully insert your index finger in the anus and a firm lump will be felt that has a consistency like hard clay.

Once you have made the diagnosis, try the least invasive methods to treat the impaction first. You are trying to soften and lubricate the hard stool.  Certain laxatives, such as Magnesium Citrate or Polyethylene Glycol, work by increasing the water content of the mass so that it is soft enough to expel. These often take time to work. Glycerine suppositories also soften the stool and increase the strength of the motion of the intestines to help with expulsion.  Finally, enemas with warm mineral oil or concentrated saline solutions may be needed for quick relief.

Sometimes, your patient may be so uncomfortable that iimmediate removal of the mass is necessary. The manual removal of hard stool is known as “disimpaction”. This is performed by heavily lubricating the inside of the anus and using one gloved finger to go along the side of the mass. Using a slow and careful bending of the finger towards the mass (away from the rectal lining), break up and scoop out the stool.  This will likely take more than one attempt and will be uncomfortable. It is important to do this in small steps as tears in the rectal lining can cause bleeding or worse, a perforation. Between attempts, use glycerine suppositories or mineral oil.  At some point, your patient is likely to pass the remaining stool on their own.

Once you have had a fecal impaction, you are more likely to have recurrences.  Prevent future episodes by increasing dietary fiber in your food storage, drinking plenty of fluids, exercising, and making a regular effort to visit the latrine after eating.

Many things you need to know as a medical resource in tough times involve unpleasant duties.  This is one of them, but imperative if you hope to be effective in your role as medic.

Dr. Bones