Constipation

Constipation in people with developmental disability is extremely common and often overlooked. It occurs in all life stages, increases with ageing, and warrants particular vigilance and active preventive measures. Constipation is distressing, and discomfort may be expressed as challenging behaviour. If constipation is suspected, it requires vigorous investigation and treatment. Severe chronic constipation may result in delayed toilet training in children, urinary incontinence, recurrent hospitalisation, intestinal obstruction or volvulus (ie twisted intestine) and death. Constipation can also cause faecal incontinence; see Continence problems in people with developmental disability for management advice.

The cause of constipation is usually multifactorial. Risk factors include:

• poor fluid intake, particularly in people who have difficulty swallowing (ie dysphagia)
• poor mobility (eg people with significant physical disability)
• severe intellectual disability
• diet related factors (eg low fibre diet)
• some drugs (eg antipsychotics).

For advice on managing constipation, see Functional constipation. Management strategies usually need to be continued long term. A continence nurse may be helpful in development, implementation and monitoring of strategies for constipation management.