Practice Easily missed?

Constipation in people with learning disability

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c222 (Published 26 January 2010) Cite this as: BMJ 2010;340:c222
  1. Justin Coleman, senior general practitioner1,
  2. Geoffrey Spurling, senior lecturer2
  1. 1Inala Indigenous Health, 64 Wirraway Parade, Inala, QLD 4077, Australia
  2. 2Discipline for General Practice, Inala Indigenous Health
  1. Correspondence to: J Coleman colross{at}tpg.com.au

    Case scenario

    A 48 year old woman with mild intellectual impairment and epilepsy (for which she takes phenytoin) presented with left sided abdominal pain. She had mentioned this before but had denied constipation or diarrhoea. We found an archived radiograph showing moderate faecal loading. When pressed, she admitted not knowing what “constipation” meant and, in fact, had been manually evacuating but was too ashamed to tell anyone.

    Chronic constipation is surprisingly common in people with learning disability. Communication difficulties, the vagueness of the symptoms, and the presence of other priorities often mean that carers and clinicians miss looking for this problem.1

    How common is it?

    • In a randomly selected institutionalised adult population of 215 people with learning disability (IQ <50), 149 cases (69.3%) had constipation2

    • In children with severe disabilities, estimates of the prevalence of constipation vary from 26% to more than 50%3

    • People with learning disability are more likely to be taking drugs that are associated with constipation, such as anticonvulsants, benzodiazepines,2 and antipsychotics

    • Other factors associated with constipation in people with learning disability include reduced physical mobility and refusal to eat2

    • Some causes of learning disability, whether inherited (such as Down’s syndrome) or acquired (such as cerebral palsy), are strongly associated with …

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