Fecal Retention in a Young Man With Traumatic Brain Injury

A 31-year-old man with a history of traumatic brain injury was hospitalized because of failure to thrive, constipation, and intermittent diarrhea with soiling.
Jon O. Ebbert, MD, and Timothy J. Young, MD, of Rochester, Minn, noted a palpable lower abdominal mass. A CT scan of the abdomen and pelvis revealed retained stool in the rectum, a rectosigmoid colon dilated to 15 cm (long arrow), and compression of the bladder (short arrow).
Regular bowel care is a fundamental but frequently overlooked component in the care of patients with CNS dysfunction. Blunted rectal sensation may account for a lack of the desire to defecate. Soiling may occur because rectal distention elicits internal sphincter relaxation at a lower threshold, while external sphincter contraction is impaired. Impaired colonic response to a meal may also contribute to constipation.
In this patient, docusate with benzocaine enemas induced large bowel movement. The patient was discharged with an aggressive bowel regimen. At follow-up, he reported normal daily bowel movements.