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‘Constipation is a symptom-based disorder which describes defecation that is unsatisfactory because of infrequent stools, difficulty passing stools, or the sensation of incomplete emptying’. (NICE)

https://cks.nice.org.uk/topics/constipation/

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The NICE Clinical Knowledge Summary (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories

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Constipation and learning disabilities. 

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Constipation and learning disabilities. 

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People with learning disabilities are more likely to experience constipation than the general population. caused by inadequate diet and fluid intake, reduced mobility and lack of exercise, and as a side-effect of medication. People with LDs may struggle to communicate symptoms and discomfort. Reduced mobility can be a problem especially if the LD is severe. Fluid and diet intake may be not optimum, especially for those with dysphagia. Medication side effects can include constipation

LeDeR’s (2019) report cited constipation in the five most-common long-term health conditions reported in the deaths of people with learning disabilities. Furthermore, the Learning Disabilities Mortality Review (LeDeR) found that 23% of deaths identified constipation as a long-term health problem and 33% were on prescribed laxatives. Another study highlighted that, while only 0.5% of the general population are on regular laxatives, this figure is 25.0% of the LD population.

Source - The nursing times

https://www.nursingtimes.net/roles/learning-disability-nurses/constipation-in-people-with-learning-disabilities-prevalence-and-impact-13-03-2023/

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-Etiological factors of constipation in the elderly, with emphasis on functional causes (journal article)- lack of exercise causes constipation

-Effectiveness of a high fiber diet in improving constipation in patients with defecatory dyssynergy under treatment with annorectal biofeedback (article)- high fibre diet lowers likelihood of constipation

-dehydration can cause constipation

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UK primary care cohort study found the prevalence of GP- diagnosed constipation was 12.8 per 1000 people (shafe, 2011, cited by NICE)

Constipation is twice as likely in black patients and also in patients in deprived socia-economic groups (BMJ Best Practice, 2020, cited by NICE)

However, it must be considered the prevelance of constipation may be underestimated in studies due to the high proportion of people self-treating rather than consulting healthcare professionals (Tack, 2011)

https://cks.nice.org.uk/topics/constipation/background-information/prevalence/#:~:text=Constipation%3A%20How%20common%20is%20it%3F%201%20A%20UK,used%20%5B%20Barberio%2C%202021%20%5D.%20...%20More%20items

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The NICE Clinical Knowledge Summary (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories

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Constipation can be short-term or long-term, depending on the underlying cause and individual circumstances.

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Condition that causes reduced, or uncomfortable bowel movements

Fewer than 3 bowel movements a week

Stools can be hard, dry, lumpy and difficult to pass

Can be experienced by all ages

Can be short or long term

Causes:

slow movement of stool through your colon

delayed emptying of the colon from pelvic floor disorders

functional gastrointestinal disorders, such as irritable bowel syndrome

not eating enough fiber

not drinking enough liquids, or dehydration

not getting enough physical activity External link

celiac disease

disorders that affect your brain and spine, such as Parkinson’s disease

spinal cord or brain injuries

conditions that affect your metabolism, such as diabetes

conditions that affect your hormones, such as hypothyroidism

inflammation linked to diverticular disease or proctitis

intestinal obstructions, including anorectalblockage and tumors

anatomic problems of your digestive tract

Treatment:

Increase liquid consumption

Increase fibre consumption

Laxatives

Physical activity

Bowel training

Positioning

Other:

People with learning disabilities more likely to experience constipation

Extreme cases can result in death, or surgery being needed

References:

Magill’s Medical Guide (Online Edition), 2023

Constipation." National Institute of Diabetes and Digestive and Kidney Diseases , www.niddk.nih.gov/health-information/digestive-diseases/constipation. Accessed 20 July 2023.

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constipation, can be improved by fiber intake, drinking plenty of water, and staying physically active. Additionally, eating fruits, vegetables, and whole grains can also promote regular bowel movements.

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Causes: can be caused by diet, and medications.

Prevelance: 74% of children at a CP outpatients clinic suffered from chronic constipation.

69.3% of inpatient adults had constipation. (2010)

Relevance to LD: People with LD are more likely to be taking medication that is associated with constipation eg epilepsy meds. Also DR rely on communicated history of abdominal symptoms and therefore recognition is delayed. (Diagnostic overshadowing)

Typical presentation: overflow, incontinence, may present as distress, sleep disturbance, or behavioural changes,

Long term impacts:

Nausea, hemorrhoids, prolapse, hospital admissions, death.

Treatable cause of unnecessary suffering