Abstract
Constipation is a condition that is very prevalent and is reported in up to 40 percent of individuals with intellectual and developmental disabilities (IDD). Constipation in this patient population is most commonly secondary to neuromuscular abnormalities, immobility, suboptimal diet, and medication side effects. History taking is frequently limited in adults with IDD due to communication barriers, often leading to a missed diagnosis of constipation. Inadequately treated constipation may lead to adverse effects including behavioral disturbances, fecal impaction, intestinal obstruction, and even death from intestinal perforation and sepsis. As a result, a high index of suspicion must exist for this patient population. Treatment in these patients requires an individualized approach, to reduce the constipation and its associated health complications.
Highlights
Introduction and Backgroundintellectual and developmental disabilities (IDD) is characterized by significant limitations in intellectual functioning and adaptive behavior as expressed in conceptual, social, and practical adaptive skills and manifested before the individual attains age 22 [1]
Constipation is a syndrome defined by bowel symptoms of difficult or infrequent passage of stool, hardness of stool or feeling of incomplete evacuation. e Rome III criteria separate constipation into two syndromes—functional constipation and constipation-predominant irritable bowel syndrome
Constipation can be classified as primary constipation which is idiopathic or functional and secondary constipation which is usually secondary to medical conditions or medications [6]
Summary
IDD is characterized by significant limitations in intellectual functioning and adaptive behavior as expressed in conceptual, social, and practical adaptive skills and manifested before the individual attains age 22 [1]. Physiologic testing is only required in patients with refractory symptoms who do not respond to conventional treatment methods [21], such as constipation refractory to dietary fiber supplementation and/or over-the-counter laxatives [6]. Patients with IDD who have behavioral issues and are on antipsychotic treatment causing constipation should be closely monitored. E initial treatment to relive the distressing symptoms of constipation may focus on increased dietary fiber intake and/or fluid intake depending on the underlying cause [6]. Patients sometimes fail therapy with increased dietary fiber intake and bulk-forming laxatives At this point, surfactants or stool softeners can be started. Class Bulk-forming laxatives Psyllium Methylcellulose Polycarbophil Surfactants Docusate sodium Docusate calcium Osmotic agents Sorbitol Polyethylene glycol Glycerin (suppository) Magnesium sulfate Magnesium citrate Stimulants Bisacodyl (oral) Senna Secretagogues Lubiprostone Linaclotide Plecanatide. Local site irritation at the rectum Mag toxicity if used in excess, urgent defecation e same as above Gastric irritation
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