Constipation in autistic people and people with learning disabilities

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Abstract

This article gives an overview of constipation and related concerns in people with learning disabilities (LDs) and/or autistic people. It provides recommendations to primary care to help address this issue. It furthers the evidence and importance of recognising and managing constipation as outlined in national guidance.1 Public Health England and the Office for National Statistics estimate that approximately 2.16% of adults and 2.50% of children in the UK have an LD. Autistic spectrum condition (ASC) is reported in approximately 2% of adults and children. It is considered that 30%–70% of people who have an ASC will also have an LD.2 People with LDs die on average 20 years earlier than the general population and suffer much higher rates of physical morbidities.3 The Learning Disabilities Mortality Review (LeDeR) found that 23% of deaths identified constipation as a long-term health problem and 33% were on prescribed laxatives.1 Another study highlighted that, while only 0.5% of the general population are on regular laxatives, this figure is 25.0% of the LD population.4 There are numerous causes for this tendency to constipation. There may be neurological and genetic causes of disordered bowel function. People with LDs may struggle to communicate symptoms and discomfort. Reduced mobility can be a problem especially if the LD is severe. Fluid and diet intake may be not optimum, especially for those with dysphagia. Medication side effects can include constipation, particularly medication with anticholinergic side effects, including opioids and psychotropic and anti-seizure medication. Autistic people (like people with LDs) experience more health inequalities compared with the general population, including higher rates of sleep problems, epilepsy, sensory impairments, allergies, autoimmune disorders, and obesity.5 Autistic people have a two to three decades’ decreased life expectancy and heightened all-cause and injury mortality.6 Atypical eating behaviours are common in those with ASC, with the most frequent being limited food preferences, food texture hypersensitivity, pica, and other unusual patterns, such as eating only one brand of food. Atypical eating behaviours are more common in ASC than in other developmental disabilities and occurrence may be as high as 70.5%.7