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

-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

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

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.

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