What is constipation and what is the scale of the problem?

Constipation is a common digestive condition.1,2 Prevalence of constipation increases with age3-5 and rates are higher among older people who live in care homes or institutions than amongst people living in the community.5

80% of people in care homes suffer from constipation.6

In many cases constipation can be prevented and/or treated effectively. It should not be overlooked, trivialised or regarded as an inevitable consequence of ageing.7,8

Consequences of untreated constipation
Chronic constipation can cause significant pain and suffering. Left untreated, it can have serious medical consequences,9 such as faecal impaction, where solid faeces are retained and prevent normal evacuation. This may require hospital intervention.10

Faecal impaction affects up to 50% of older adults in hospital wards or care homes.11,12 Faecal impaction can also lead to faecal incontinence, where loose stool leaks from around the impacted faeces.

Impact of constipation on patient quality of life
Constipation can significantly reduce a patient’s quality of life and may be associated with high levels of anxiety and depression, as well as embarrassment and loss of dignity.13-15 Untreated constipation can impact on the management of patients with cognitive or neurological illness and may lead to irritability or confusion in those with dementia.15,16

Economic cost of constipation
Constipation represents a significant burden on health resources in terms of nursing time, investigation, intervention, medication and on-going management.5,10,13

In England in 2011, 61,162 hospital admissions were due to a primary diagnosis of constipation.17; 80% of these were emergency admissions and led to an average stay of 4.9 bed days.17

Constipation associated with incontinence can lead to the breakdown of care at home and may be responsible for premature admission to care homes.8

References

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  1. Belsey J, Greenfield S, Candy D et al. ‘Systematic review: impact of constipation on quality of life in adults and children’, Aliment Pharmacol Ther, 2010, vol. 31, pp. 938-49.

  2. Clinical Knowledge Summaries, Constipation, retrieved 3 September 2013, http://www.cks.nhs.uk/constipation.

  3. Peppas G, Alexiou V, Mourtzoukou E, et al. ‘Epidemiology of constipation in Europe and Oceania: a systematic review’, BMC Gastroenterology, 2008, vol. 8, no. 5, pp. 1-7.

  4. Talley N, ‘Definitions, epidemiology, and impact of chronic constipation’ Rev Gastroenterol Disord, 2004, 4 Suppl 2:S3-S10.

  5. American Gastroenterological Association, ‘Technical Review on Constipation’, Gastroenterology, 2013, vol. 114, pp. 218-238.

  6. Potter J and Wagg A, ‘Management of bowel problems in older people: an update’, Clin Med, 2005, vol. 5, no. 3, pp. 289-95.

  7. Castledine G, Grainger M, Wood N et al. ‘Researching the management of constipation in long-term care: Part 1′, Brit J Nurs, 2007, vol.16, no.18, pp. 1128-31.

  8. Wilson L, ‘Understanding bowel problems in older people: part 1′, Nursing Older People, 2005, vol.17, no. 8, pp. 24-29.

  9. Gallagher P and O’Mahoney D. ‘Constipation in old age’, Best Practice & Research Clinical Gastroenterology, 2009, vol. 23, pp. 875-87.

  10. Addison R, Davies C, Haslam D et al. ‘A national audit of chronic constipation in the community’, Nursing Times, 2003, vol. 99, no. 11, pp. 34-35.

  11. Barcelo M, Garcia-Sanchez R, Diaz-Rubio M, et al. ‘Prevalence of fecal impaction among residents in nursing homes in Spain and associated factors’, Gastroenterology, 2012, vol. 142, no. 5, pp. 445-46.

  12. Spinzi G, ‘Bowel care in the elderly’, Dig Dis, 2007, vol. 25, pp. 160-65.

  13. Norton C, ‘Constipation in older patients’, Brit J Nurs, 2006, vol. 15, no. 4, pp. 188-92.

  14. Woodward S, ‘Assessment and management of constipation in older people’, Nursing Older People, 2012, vol. 24, no. 5, pp. 21-26.

  15. Eberhardie C. ‘Constipation: Identifying the problem’, Nursing Older People, 2003, vol. 15, no. 9, pp. 22-26.

  16. Alzheimer Scotland, Information Sheet IS41, retrieved 3 September 2013, http://www.alzscot.org/pages/info/constipation-faecal-impaction.htm.

  17. Dr Foster Health, Hospital Episode Statistics (HES), 2011.