Faecoliths (Fecaliths): Causes, Symptoms, and Management

A faecolith (fecalith) is a hardened, desiccated mass of stool that forms in the colon or rectum. It can cause obstruction, pain, and complications if not addressed. Faecoliths are more common in older adults and those with chronic constipation, neurological conditions, or limited mobility.

Causes and Risk Factors

• Chronic constipation and stool withholding
• Dehydration and low-fiber diet
• Medications: opioids, anticholinergics, calcium/iron supplements, diuretics
• Neurological disorders: Parkinson's disease, spinal cord injury, multiple sclerosis
• Metabolic conditions: diabetes, hypothyroidism
• Structural anomalies: strictures, Hirschsprung disease, megacolon
• Immobility or bedbound status

Symptoms

• Abdominal pain, cramping, or distension
• Constipation or obstipation (no stool/gas passage)
• Overflow diarrhea (liquid stool bypassing the mass)
• Nausea, vomiting (if obstruction)
• Rectal pressure, tenesmus, or palpable mass
• Hematochezia (bright red blood from mucosal trauma)

Diagnosis

• Digital rectal exam (often reveals hard mass)
• Abdominal X-ray or CT scan (calcified mass, colonic dilation)
• Colonoscopy if malignancy suspected or for therapeutic removal

Treatment

Conservative (for small, proximal faecoliths)

• Oral hydration and osmotic laxatives (PEG 3350, lactulose)
• Stimulant laxatives (senna, bisacodyl) if no obstruction
• Enemas (saline, mineral oil, phosphate) or suppositories (glycerin, bisacodyl)

Manual Disimpaction

Digital fragmentation and removal under sedation/anesthesia for rectal faecoliths. Requires skill to avoid perforation.

Endoscopic or Surgical Removal

For large, proximal, or complicated faecoliths (obstruction, perforation, peritonitis).

Prevention

• Adequate fluid intake (1.5–2 L/day unless contraindicated)
• High-fiber diet (25–35 g/day) or fiber supplements
• Regular physical activity
• Scheduled toileting routines (especially post-meal)
• Medication review to minimize constipating drugs
• Manage underlying conditions (thyroid, diabetes, neurological)

When to Seek Urgent Care

Severe abdominal pain, vomiting, distension, fever, or inability to pass gas/stool—signs of possible obstruction or perforation requiring immediate evaluation.