Constipation

Trivial in most people, and a genuine cause of death in some. In care, it deserves far more attention than it gets.

What it is

Nobody expects to find constipation in a serious list of health conditions. Put it here anyway, because in learning disability and older people's services it is one of the conditions most likely to cause avoidable harm.

The LeDeR reviews into deaths of people with a learning disability have repeatedly identified constipation as a contributing factor in deaths that should not have happened. Not as a nuisance. As a cause.

Ordinary constipation is infrequent, hard or difficult-to-pass stools. What makes it dangerous is when it is not noticed, in somebody who cannot report it, until it has become impaction or obstruction.

Signs you might notice

Fewer than three bowel movements a week, or straining, or stools like pellets.

Stomach pain and bloating, sometimes with reduced appetite.

Overflow diarrhoea, which is the trap: liquid stool leaking past an impaction looks like the opposite problem and gets treated as one.

In someone who cannot tell you: behaviour change, agitation, refusing food, guarding the abdomen, vomiting. Behaviour that gets recorded as challenging is very often pain.

How it can affect day-to-day life

Risk stacks up fast in care settings. Reduced mobility, low fibre, poor fluid intake and medication all push in the same direction, and many common drugs cause constipation: opioids, some antipsychotics, iron, anticholinergics.

For someone with a learning disability or dementia, the person who could report the symptom is often the person least able to.

Untreated impaction leads to obstruction, perforation and sepsis. That is the pathway that turns a nuisance into a death.

Supporting someone well

Record bowel movements properly, using the Bristol Stool Chart, for anybody who cannot reliably report their own. Not as a box-ticking chore, as an observation with a threshold attached: three days without, act.

Get the fluid in. This is the commonest gap, especially where staff are worried about continence.

Move. Even small amounts of walking help significantly.

Review medication. Ask a pharmacist which of the current drugs cause constipation and whether any can change.

Do not treat overflow diarrhoea with anti-diarrhoeals. Check for impaction first.

Fiducia Together keeps bowel monitoring in the clinical record with the medicines beside it, which is what turns three separate shift notes into a pattern somebody acts on.

Where to get help

A GP or practice nurse can prescribe and, importantly, review. Laxatives are not all the same and using the wrong type is common.

Get urgent help for severe abdominal pain, vomiting, no bowel movement combined with a distended abdomen, or blood.

For anybody with a learning disability, ask for an annual health check. Bowel health is part of it and it is one of the things the check exists to catch.