Stool impactions probably aren’t what most people would consider an “emergency” … until they actually have a stool impaction. Personally, I wouldn’t wish a stool impaction on someone. In chronic constipation, more and more stool collects in the colon until size of the ball of stool is too big to pass through the opening to the outside world. The major function of the colon is to absorb water from the stool, so the longer the stool sits in the colon, the larger the amount of water that gets absorbed, and the harder the blob of stool gets. By the way – the whole water absorbing function of the colon is why it is important to keep well hydrated to maintain good bowel habits.
There are a lot of ways that you can try to get rid of a stool impaction, but when the stool gets hard enough, pretty much the only way to remove the impaction is by having someone use their fingers to perform a “disimpaction.” There’s just no good way to get a big hunk of stool the consistency of clay soft enough for it to pass through the rectum. It has to be dug out.
Disimpactions aren’t fun for the doctor or the patient. They’re painful and obviously messy. I’m probably more willing than most docs to perform disimpactions because I can see how much the patients are suffering. Although unpleasant, disimpactions are an easy fix to the patients’ problem. Like I said, you probably can’t appreciate how bad impactions are until you’ve been on the other side of the gloved finger.
As I donned my mask, gown, and multiple layers of gloves to commence the procedure on one patient, one of the nurses sent a nursing student in the room with me to observe. The student said that she had seen “many” disimpactions in the past, but the nurse wanted her to observe this one, so she reluctantly came in the room with me.
I introduced the student to the patient, then had the patient lay on his side and pull his knees to his chest. The nursing student stood against the wall behind me.
“OK, Mr. Smith, you’re going to feel some pressure. I’ll try to be as gentle as I can.”
The patient muffled his moans as I began removing stool. Although the large impaction appeared relatively solid on the x-ray, the initial pieces of stool that came out were in little round globs.
Then the nursing student tells the patient “Oh, you just have little balls. This shouldn’t be too bad.”
I stopped for a second and cocked my head to the side. In the awkward silence that followed, the student realized what she had said and tried to correct herself.
“I mean little balls in your rectum.”
I looked back at her and started to chuckle.
“I mean little balls of stool.”
At that point, she was beet red and she excused herself from the room.
“Sorry about that, Mr. Smith, she’s still learning.”
“She had me worried there for a second. I thought you were going to go grabbing my nuts next.”
The nursing student had taken an afternoon lunch break by the time I had removed all the “little balls.”
I was hoping they were serving spaghetti with meatballs so I could ask the student if she gloved up before lunch, but no such luck.
This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.