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What is constipation?
Constipation is when a person has bowel motions which are hard to pass, has fewer bowel motions than normal, or has no bowel motions at all.
What is normal?
- The number of times, or time of day, that a person goes to the toilet to pass faeces is different for each person.
- 'Normal' can be one to three times a day to three times a week.
- It is important to know what is normal for the person you support. This will help you notice if something changes.
What causes constipation?
There are a lot of reasons why constipation happens including:
- not eating enough fibre (see Healthy Diet and Bowels resource)
- eating too much fibre without drinking enough fluid
- not drinking enough fluids
- not exercising or moving enough
- side effects of some medicines - especially ones used for pain, some mental health conditions or to manage urinary incontinence
- not being able to get to the toilet on their own or quickly enough when they need to
- if the person has a disability, because it can affect:
- how well they can sit on the toilet or commode
- how much they can eat of drink.
- some medical conditions such as:
- nervous system disease e.g. spinal cord injury, spina bifida, multiple sclerosis, or Parkinson's disease - these can affect how quickly the stool moves through the bowel and how well the rectum can empty
- bowel disease, e.g. irritable bowel syndrome, haemorrhoids or diverticular disease.
- refusing to sit on the toilet because of:
- a lack of understanding or fear
- pain when faeces are passed
- lack of privacy or embarrassment.
- poor toilet habits:
- not sitting on the toilet in the right position
- standing over the toilet seat (hovering) instead of sitting down
- ignoring or not understanding the urge to go
- not sitting long enough on the toilet or rushing.
How is constipation treated?
There are a lot of ways to treat and manage constipation. Talk to your supervisor, care coordinator, or a health care professional if you are not sure what to do, or are worried about the person's health.
Here are some things you could try.
1. Make changes to their diet.
- Make sure the person is eating enough fibre every day.
- Think about getting help from a dietitan to change or make a diet plan.
- Think about getting help from a speech pathologist if the person has trouble chewing or swallowing their food.
- Think about getting help from an occupational therapist if the person has trouble using their hands and can't cut up food.
- A visit to the dentist may be needed to see if bad teeth are causing pain. This might be why the person isn't eating enough fibre.
2. Help the person to drink more fluids.
- Monitor how much fluid the person drinks each day. For more information see Fluids.
- If fibre increases in a person's diet, make sure they have more fluids as well.
- Make sure any meal plans designed for the person are being followed.
- Offer fluids regularly, especially in hot weather (unless the person is on fluid restrictions).
- Give the person fluids that they enjoy, such as their favourite drinks, icecream or frozen fruit drinks.
- Important: always check with a health care professional before giving more fluids to make sure it is safe for the person.
3. Help the person be more active.
- Help or encourage them to walk when possible.
- If someone uses a wheelchair or mobility equipment, moving them regularly can help, e.g. the use of standers when possible to maximise gravity.
- Follow exercise and positioning plans if the person has them.
- A referral to a physiotherapist might be needed.
4. Help the person to use the toilet when needed.
- Make sure you are following the person's toileting or bowel management plan if they have one.
- Most people need to go to the toilet first thing in the morning or about 2O minutes after eating. This is a good time to try and help the person go.
- For some people, a hot drink in the morning can be helpful to get the bowels moving.
- Look at how the person is sitting on the toilet. They should sit with their knees bent above the level of the hips and have their feet flat on the floor. They might also need a small footstool under their feet.
- If the person has a physical disability, make sure any supportive devices are used. Look at their use in case their needs have changed.
5. Know what is normal for the person and take action if this changes.
- Ask the person, their family or other support workers what is normal for them if you can't tell from their care, toileting or bowel management plan.
- Keep a record of bowel movements on a bowel chart.
- Look at any signs that the person is uncomfortable. If the person is non-verbal, look at their bowel chart regularly.
- Look in the toilet bowel after they have had a bowel motion. Compare the bowel motion to the Bristol Stool Chart and see if there is a change. Record any changes on their bowel chart.
6. Medicines can be looked at by a general practitioner (GP) or nurse practitioner to see if any are causing constipation. If possible, the medicine might be changed or a laxative might be prescribed.
7. If they have been ordered a laxative by a GP or nurse practitioner, make sure that they have taken them.
- If the bowel motion becomes too runny or the person won't take the laxative, tell your supervisor, care coordinator, or their GP so they can look at the plan.
8. If there are changes in the person's bowel habits, talk to your supervisor, the person's care coordinator or a health care professional. Constipation can get worse and be a serious problem if it is not treated.
If the person you support has a spinal injury above T6, make sure that you know the signs and symptoms of autonomic dysreflexia.
Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.
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