Constipation in itself causes all kinds of problems for so many patients.

And when it gets really bad, sometimes people form fecalomas, which are these rock-hard masses

of stool that are tumor-like inside the colon.

It's just beyond ordinary constipation because these masses of stool get so impacted

that they cause bowel obstruction and sometimes urinary tension and pressure ulcers or even

perforation of the colon. And you see this frequently in those who are immobile, the elderly, and definitely in those

taking opioids. And while you may just present with abdominal pain and constipation and nausea and vomiting,

there's often diarrhea because it's overflow diarrhea where paradoxically you're having these loose stools leaking

around the impaction. And so you'll often see it on CT where there's a large,

dense stool burden with colonic dilation. It can mimic malignancy even on a CT scan. And then we'll often see the complication

of stucral colitis where pressure from impacted stool compromises blood flow and that inflames

the bowel wall. And so usually the treatment is a very aggressive bowel regimen like enumas,

manual disimpaction, which we all hate doing, but we have to do sometimes, and hydration. And that's all

done if things are actually going pretty well. A lot of times things are not going well, so you have to try endoscopic fragmentation,

and there are times where you need surgery because there's ischemia or perforation or complete

obstruction. Fecalomas can be catastrophic. They can be a cause of death. And one of the big

problems, obviously, is that it's usually a frail

population. So somebody with significant neurologic disease, or more frequently for me, I see a lot of

elderly people, nursing home patients that have this issue. And these are the last people that you

want to put under anesthesia and do invasive procedures with.

And what's super frustrating with these situations of fecalomas is oftentimes you give the enum,

you're doing aggressive bowel regimens, and you are not improving the situation. By all means, try those measures. They

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