There are a series of therapeutic interventions the surgeon executes with his hands upon the wake patient which produce immediate cessation of discomfort and pain. Among them, the removal of fecalomas is unglamorous and avoided by many, who miss the gratification of rapid patient relief.

Fecalomas are faecal formations which have lingered in the large bowel, much longer than would be normal or desirable, therefore undergoing excessive reabsorption of water. Progressively dehydrated and hard, they become unmalleable and consequently tougher to push towards the anus.

Anyone may develop a fecaloma. The chances one may form, however, relate to transit time – the time it takes stool to travel through the large bowel until it´s expelled, the amount of fibre in the diet, the consumption of water and the degree and type of physical activity, among other more complex and less frequently implicated factors.

What might come of a fecaloma? An obstruction to defecation, be it complete or partial. According to the case, symptoms will be more or less pronounced, more or less sudden, more or less severe.

A partial obstruction conditions the passage of normal stool that has since been formed without impeding it, the passage of liquid stool and gas, which easily passes around the obstacle, being favoured. The hard and possibly large obstacle, unable to overcome the distended anus, remains within the large bowel or rectum. The patient maybe bloated with gas and complain of colicky pain.

A complete obstruction will not allow the passage of more recently formed faeces. The fecaloma has grown and adjusted to the diameter of the bowel, also impeding the passage of fluids and gas. The patient will be uneasy and plaintiff, present with a stiff belly, sensitive to touch and with colicky pain, will refuse to eat and might be nauseated or vomit. This situation constitutes an emergency, treatment being the fragmentation and removal of the fecaloma (which is not always easy), or an emergency surgical intervention, in case there is impending or verified rupture and possible need for excision of a portion of bowel. In the fragile elderly, with multiple maladies, an endless list of medications and very reduced tolerance to additional stress, an event like this might dictate death. It´s baffling how something as prosaic as a lump of hardened stool may lead to such a dramatic circumstance.

It is easily deductible that those who ingest little water and spend their days confined to a bed are at risk of developing a fecaloma. Those who are not sat upright frequently, made to squat after a meal, left to groan all day losing water in every breath and unsupervised concerning bowel habit are at greater risk. Ending that way is senseless.

Drinking water, eating fruit and vegetables, moving about and going to the toilet whenever the body says it´s time are simple attitudes which avoid the formation of fecalomas. Be active in preventing a visit to the emergency department due to a fecaloma – be it yours, or your elderly loved ones´!