SCF ENCYCLOPEDIA ENTRY

FECAL IMPACTION

SCF-RDOS Registry Code: SCF-RDOS-PPD-GI-004

Disease Type Classification: Gastrointestinal Disease → Colorectal Motility Disorder → Postpartum Fecal Impaction Syndrome

Adaptive Module Activation:

• Universal Core Module
• Gastrointestinal Disease Expansion
• Neuroenteric Expansion
• Pelvic Floor Dysfunction Expansion
• Connectomic Expansion
• Tissue Injury Expansion
• Microbiome Expansion

1. SCOPE & POSITIONING

Etiology / Classification

Fecal Impaction is a severe gastrointestinal disorder characterized by the accumulation of hardened fecal material within the rectum, sigmoid colon, or distal large intestine, resulting in mechanical obstruction of normal stool passage and failure of spontaneous evacuation.

In the postpartum setting, fecal impaction most commonly develops as a progression of untreated or severe postpartum constipation and is frequently associated with:

• Vaginal delivery
• Perineal trauma
• Episiotomy
• Cesarean recovery
• Opioid analgesic exposure
• Iron supplementation
• Pelvic floor dysfunction
• Defecatory avoidance behavior
• Reduced mobility
• Dehydration

Within the SCF framework, Fecal Impaction is classified as:

A neuroenteric–pelvic evacuation failure syndrome characterized by severe stool retention, colonic transit arrest, anorectal dysfunction, and progressive gastrointestinal mechanical obstruction.

SCF Classification

SCF Disease Category: Gastrointestinal Evacuation Failure Syndrome

SCF Functional Class:

Maternal Colorectal Transit and Elimination Collapse Disorder

SCF Fault Tier Classification

Clinical Significance

Fecal Impaction represents one of the most severe complications of postpartum constipation and may lead to significant morbidity if untreated.

Potential complications include:

• Severe abdominal pain
• Rectal pain
• Fecal overflow incontinence
• Hemorrhoids
• Anal fissures
• Stercoral ulceration
• Colonic obstruction
• Rectal ischemia
• Bowel perforation (rare)
• Sepsis (rare)

SCF Domain Alignment

Primary Domains:

• Gastrointestinal
• Neuroenteric
• Colorectal
• Pelvic Floor

Secondary Domains:

• Connectomic
• Microbiome
• Inflammatory
• Musculoskeletal

2. ETIOPATHOGENIC CORE

Primary Cause

Fecal Impaction develops through convergence of:

• Severe constipation
• Progressive stool dehydration
• Colonic transit arrest
• Defecatory dysfunction
• Pelvic floor dyssynergia
• Neuroenteric dysregulation
• Mechanical evacuation failure

Key Drivers

Driver A — Severe Stool Retention

Delayed transit permits:

• Excessive water absorption
• Stool hardening
• Fecal mass enlargement

Result:

• Impaction formation

Driver B — Defecatory Avoidance

Postpartum women may avoid bowel movements because of:

• Perineal pain
• Episiotomy discomfort
• Anal fissures
• Hemorrhoids

Result:

• Progressive stool accumulation

Driver C — Pelvic Floor Dysfunction

Contributors include:

• Pelvic floor injury
• Pudendal nerve dysfunction
• Dyssynergic defecation

Result:

• Impaired evacuation

Driver D — Neuroenteric Transit Failure

Altered:

• Enteric nervous system signaling
• Autonomic regulation
• Colonic peristalsis

Result:

• Transit arrest

Driver E — Medication-Induced Motility Suppression

Common contributors:

• Opioids
• Iron supplementation
• Reduced physical activity

Result:

• Worsening stool retention

3. SCF FAULT ARCHITECTURE

4. PATHOGENESIS FLOW (SCF LOGIC)

Postpartum Constipation

↓

Delayed Colonic Transit

↓

Excess Water Reabsorption

↓

Hard Stool Formation

↓

Defecatory Avoidance

↓

Progressive Stool Accumulation

↓

Rectal Distension

↓

Pelvic Floor Dysfunction

↓

Evacuation Failure

↓

Large Hardened Fecal Mass

↓

Fecal Impaction

↓

Mechanical Obstruction

↓

Colorectal Complications

5. CLINICAL SPECTRUM

6. SCF TRINITY FRAMEWORK MAPPING

Trinity Axis I — Structural Integrity

Affected Systems:

• Rectum
• Sigmoid colon
• Anal canal
• Pelvic floor structures

Primary Failure:

• Mechanical evacuation failure

Trinity Axis II — Energetic Integrity

Affected Systems:

• Enteric neurons
• Colonic smooth muscle
• Gastrointestinal motility pathways

Primary Failure:

• Transit-generating bioenergetic dysfunction

Trinity Axis III — Informational Integrity

Affected Systems:

• Enteric nervous system
• Gut-brain axis
• Pelvic neuromuscular coordination

Primary Failure:

• Evacuation signaling desynchronization

7. GASTROINTESTINAL EXPANSION MODULE

Clinical Subtype Registry

Type A

Rectal Fecal Impaction

Characteristics:

• Distal rectal accumulation
• Most common subtype

Type B

Sigmoid Fecal Impaction

Characteristics:

• More proximal retention
• Greater obstruction risk

Type C

Pelvic Floor Dysfunction-Associated Impaction

Characteristics:

• Dyssynergic evacuation
• Neuromuscular impairment

Type D

Medication-Associated Impaction

Characteristics:

• Opioid-associated
• Iron-associated

Type E

Complicated Fecal Impaction Syndrome

Characteristics:

• Stercoral injury
• Overflow incontinence
• Obstructive complications

8. MULTI-OMICS PATHOGENESIS MAP

9. SCF PCR THERAPEUTIC STRATEGY

PREVENTATIVE

Objectives

Prevent progression from constipation to impaction.

Targets:

• Stool hydration
• Transit efficiency
• Pelvic floor function
• Early constipation management

CURATIVE

Objectives

Relieve impaction and restore evacuation.

Targets:

• Fecal obstruction
• Rectal overdistension
• Transit failure
• Pelvic dysfunction

Interventions:

• Manual disimpaction when required
• Rectal therapies
• Bowel-cleansing protocols
• Pelvic floor rehabilitation
• Medication review

RESTORATIVE

Objectives

Re-establish normal gastrointestinal elimination function.

Targets:

• Enteric nervous system recovery
• Pelvic floor coordination
• Microbiome restoration
• Colonic motility normalization

Potential strategies:

• Neuroenteric rehabilitation platforms
• Precision microbiome restoration
• Pelvic floor regenerative programs
• SCF-derived gastrointestinal restorative therapeutics

10. CURRENT STANDARD OF CARE

Diagnostic Evaluation

Clinical Assessment

• Bowel movement history
• Constipation severity assessment
• Overflow incontinence evaluation
• Pain assessment

Physical Examination

• Abdominal examination
• Digital rectal examination

Additional Evaluation

When clinically indicated:

• Abdominal radiography
• CT imaging
• Colonic transit studies
• Anorectal manometry

Treatment

Acute Management

• Manual disimpaction
• Rectal enemas
• Suppositories
• Osmotic bowel regimens

Supportive Management

• Hydration optimization
• Dietary fiber management
• Mobilization
• Pelvic floor rehabilitation

Long-Term Prevention

• Constipation prevention protocols
• Defecatory retraining
• Medication adjustment

11. SCF THERAPEUTIC ENGINEERING OPPORTUNITIES

SCF Target Cluster A

Neuroenteric Restoration Platform

Targets:

• Enteric neuronal signaling
• Serotonergic regulation
• Motility pathways

SCF Target Cluster B

Pelvic Evacuation Synchronization Platform

Targets:

• Pelvic floor coordination
• Pudendal nerve recovery
• Defecatory biomechanics

SCF Target Cluster C

Microbiome Resilience Platform

Targets:

• Short-chain fatty acid production
• Motility-supportive microbial communities
• Colonic ecosystem recovery

SCF Target Cluster D

Colonic Motility Optimization Platform

Targets:

• Smooth muscle contractility
• Transit regulation
• Autonomic-enteric communication

12. TRANSLATIONAL BLUEPRINT

Diagnostic Biomarkers

Gastrointestinal

• Colonic transit parameters
• Rectal evacuation metrics

Microbiome

• Short-chain fatty acid profiles
• Microbial diversity markers

Neuromuscular

• Anorectal manometry measurements
• Pelvic floor functional assessments

Inflammatory

• Local gastrointestinal inflammatory biomarkers

Clinical Endpoints

Primary:

• Complete resolution of impaction

Secondary:

• Restoration of spontaneous bowel movements
• Improved evacuation function
• Reduced recurrence
• Improved quality of life

FDA Translational Pathway

Preclinical

↓

IND

↓

Phase I Safety

↓

Phase II Proof-of-Concept

↓

Phase III Outcomes

↓

NDA/BLA Submission

13. SCF DBI INTERPRETATION

Decentralized Biological Intelligence Failure

Cellular Layer

Enteric neuronal and smooth muscle networks fail to maintain coordinated transit.

Tissue Layer

Rectal and colonic tissues become overwhelmed by progressive stool accumulation.

Organ Layer

The colorectal evacuation system loses its ability to effectively eliminate waste.

System Layer

Gut-brain-pelvic floor communication becomes trapped in a cycle of retention and dysfunction.

Whole-Organism Layer

Maternal postpartum recovery becomes impaired by severe elimination failure and gastrointestinal obstruction.

14. SCF LAYMAN’S SUMMARY

Fecal Impaction is a serious condition in which a large, hardened mass of stool becomes stuck in the rectum or colon and cannot be passed normally.

According to the SCF model, the condition develops when postpartum constipation, pain, pelvic floor dysfunction, reduced mobility, and altered gut signaling combine to slow bowel movement and cause progressive stool accumulation. Over time, the stool becomes increasingly hard and forms a blockage that prevents normal evacuation.

Common symptoms include:

• Inability to pass stool
• Severe constipation
• Rectal pain
• Abdominal discomfort
• Bloating
• Nausea
• Leakage of liquid stool around the blockage (overflow incontinence)

Prompt treatment is important because severe impaction can lead to bowel injury, infection, or intestinal obstruction if left untreated.

SCF-RDOS INDICATION SUMMARY