Constipation in people with learning disability

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.

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 …