The Fatal Four: How Constipation Impacts Health

An estimated 42 million people in the U.S. suffer from constipation, reports the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This makes constipation among the most common gastrointestinal (GI) problems people live with, aside from acid reflux. Unfortunately, specific statistics on the prevalence of constipation among those with intellectual disability are not available.

Constipation, the second of the “Fatal Four” conditions, “is commonly seen among persons with IDD and may lead to serious complications,” explains the University of Texas Health Science Center at Houston. However, the definition of constipation may vary from region to region, and some people may have odd bowel movement patterns. This does not excuse extended periods of not having a bowel movement as common practice, nor does it mean that short bouts of constipation are harmless.

To provide better care to those you serve, you need to understand how constipation impacts the quality of life and health of people with an intellectual or developmental disability (IDD).

Who Does Constipation Affect Most?

Constipation affects people of all ethnicities and socioeconomic backgrounds, but it tends to impact specific groups more often. Women, older adults, non-Caucasians, people of lower incomes, people recently released from surgery or hospitalization, those taking pain medications or medications for mental issues, and people with limited access to water have a higher risk of suffering from constipation. In fact, many of the conditions experienced in these groups may also be causes of constipation.

Recall that dehydration is another of the “Fatal Four” conditions that affect individuals with intellectual disability disproportionately.

For example, a person who recently underwent surgery may develop constipation from the use of pain medications. Or, a person eating unhealthy foods, targeting a low-income buyer, may begin to experience poor motility in the digestive system.

As of 2013, the most recent year for which specific statistics are available, many of these groups reflect common disparities in the healthcare of individuals with intellectual disability, explains the National Institutes of Health: Research Portfolio Online Reporting Tools (RePORT). However, pairing the prevalence of being diagnosed with intellectual disability among these groups results in a higher risk for constipation than the public. In other words, individuals with IDD may require extra care in preventing and treating constipation.

What Are the Complications From Constipation?

Complications during or following constipation may vary heavily. Depending on the extent and duration of constipation, the complications grow more serious.

For example, constipation that is left untreated may progress into a bowel blockage, creating a permanent form of constipation, which may require surgery to be corrected. However, additional complications can still occur, and each complication may include its own set of unique secondary complications. According to the Mayo Clinic, possible complications may include the following:

• Anal fissures – These small tears in the skin of the anus may provide an entry-point for bacteria in the stool to move into the bloodstream. These fissures may also become infected or cause additional pain when a person is trying to have a bowel movement.
• Hemorrhoids – When an individual is unable to produce a bowel movement, additional strain may cause a swelling of the veins in the anus, which contributes further to constipation.
• Impaction – Impaction describes a condition in which stool has hardened in the colon or rectum and cannot be removed through routine bowel movements. Manual removal of fecal matter, enemas or laxatives may help reduce impaction.
• Rectal prolapse – Additional straining may lead to the extrusion of a portion of the rectum through the anus. This may lead to bleeding, hemorrhoids, anal fissures and additional pain.
• Changes in appetite or weight – Weight loss is both a complication and a warning sign of constipation. Chronic constipation may cause a person to stop eating, or decreased appetite may indicate the start of constipation.

Since preventing pain and increasing the quality of life among those you serve should be the goal of your organization, the key to reducing complications is to prevent constipation from occurring.

Tips to Prevent Constipation

Depending on the care requirements of those you serve, you may not be aware of every time a person has a bowel movement. Direct support professionals (DSPs) and shift supervisors may rely on self-reporting of bowel movements, but an effective means of dealing with constipation goes back to preventing it from occurring and eliminating the worsening of symptoms, explains WebMD. Use these six tips to help your staff members reduce the risk for constipation among those with intellectual disability.

1. Promote a Well-Balanced Diet.

A well-balanced diet promotes the body’s nature movement of fluids and materials through the digestive system.

2. Increase Fluid Intake.

Dehydration may contribute to constipation, so increasing fluids can help improve the motility of stool through the intestines.

3. Discourage Caffeine Consumption.

Caffeine causes dehydration, increasing the risk for constipation. Avoid offering caffeine-containing beverages to those with signs of constipation.

4. Reduce Intake of Dairy Products.

Some may have an intolerance for dairy, causing diarrhea, which may ultimately lead to constipation.

5. Integrate Physical Activity Into Your Programs.

Physical activity increases the motility of the digestive tract, and it can help prevent stool from becoming lodged in the intestines.

6. Never Make Someone “Hold It.”

“Holding it” leads to greater hardening of stool, which may cause constipation. Unless absolutely necessary, never advise someone to “hold it.”

Help Make Constipation Go Away Through Education and Prevention

Constipation can be a warning sign of other health problems, such as dehydration or illness. When caused by lifestyle choices, such as a poor diet, constipation is almost entirely preventable, and if you know what to look for, you might say constipation is preventable in nearly any case. However, you must learn how to interact with those around you to encourage the individuals you serve to report unusual bowel habits or symptoms.

This goes back to identifying constipation early, before it causes complications that warrant hospitalization or invasive procedures. Ultimately, having more information available about this condition in the “Fatal Four” can help your organization better serve those at higher risk. Constipation does not feel good, so do what you can to prevent it.