Constipation and bowel health awareness session. Kirklees LD Community Nursing Team - PowerPoint Presentation

1. Constipation and bowel health awareness session. Kirklees LD Community Nursing Team

2. What is constipation? Constipation is when your stools become hard and you find it more difficult or painful to go to the toilet. NHS (2017) explain constipation as: -Not opening your bowels 3 times in one weekYour stools being difficult and large to pass Your stools being hard and lumpy.

3. 3 Categories of constipationPrimary – no underlying cause and largely associated with lifestyle factorsSecondary – Exacerbated by physiological /medical conditions such as; cerebral palsy, diabetes, hypothyroidism, depression.iatrogenic- Due to side effects of medications such as opiates

4. The digestive system and journey of food (easy and quick version!)

5. Symptoms of constipationAbdominal pain/crampsBloatingBeware of when the wind stops (obstruction)Loss of appetiteNauseaOverflow diarrhoeaFaecal impactionFaecal vomitingRectal bleeding when defecating. Anal fissures are associated with chronic constipationTwisting of the bowel leading to severe complicationsConstipation can be dangerous and life threatening if left untreated

6. Faecal impactionA faecal impaction is a solid, immobile bulk of faeces that can develop in the rectum as a result of chronic constipation

7. Prevalence of constipation in people with learning disabilitiesPeople with LD are more likely to suffer from constipationSome studies identify rates of 50% 25% on repeat prescription for laxatives18.8% of people with downs syndrome prescribed laxatives (compared to 3.4% of general population).Health problem for 59.8% of profound and multiple disabilitiesReference ‘Making reasonable adjustments for people with learning disabilities in the management of constipation’ (DoH 2016).

8. Commonly prescribed laxativesBulk forming laxatives – i.e . Fibogel – increase bulk of the stool to stimulate the bowelOsmotic laxatives i.e lactulose, macrogols (Laxido, Movicol) – draw water from the rest of body into the bowel to soften poo and make it easier to passStimulant laxatives i.e Senna, Bisocodyl – stimulate gut muscles to move the poo alongPoo softener laxatives i.e Docusate sodium – increases the amount of water the stool absorbs(reference nhs.uk/conditions/laxatives)

9. What contributes to constipation for our client group?Poor diet and fluid intake Reduced physical mobilityBeing prescribed medications such as antipsychotics, antidepressants and anticonvulsants.Body shape distortion Abnormal muscle toneEnvironmental factors such as lack of privacy/poor facilities/lack of suitable adaptationsChanges to care/routine causing negative effect on bowel habitsChallenging behaviourLack of understandingSensory issuesCommunication issues with poor reporting of problems/symptoms

10. SERIOUS CASE REVIEWRichard Handley – 33 years of age, Down’s syndrome, associated health problems and lifelong constipationhttps://www.bing.com/videos/search?q=richard+handley+you+tube&view=detail&mid=E9081F7040FCAF7924C0E9081F7040FCAF7924C0&FORM=VIRE

11. AVOIDING CONSTIPATIONDiet – promoting a healthy balanced diet which includes adequate fibre. Insoluble and soluble fibre which helps to bulk and soften stools Fluid intake – Recommended amount of fluid for average person 2 – 2.5 litres daily. Needed to avoid hard stoolsExercise – Exercising regularly helps to keep your digestive system healthy . Any exercise is better than nothing. Being sedentary contributes to constipation.Toileting – Routine and good toilet habits. Adequate support provided with necessary aids and adaptions for good positioning if needed

12. Our roleGP/medical consultation on constipation should always be sought to rule out underlying causes. A baseline assessment should be completed. A physical examination is usually necessary. Further investigation may be required such as CT scan/ultrasound scan. Having detailed history of problems, frequency and consistency of bowel movements, childhood constipation? Good awareness and knowledge to recognise signs and symptoms of constipation. Good monitoring and assessment. Clear bowel management/care plans in place which are reviewed regularly.Be aware and record behaviour/mood changes that could indicate a problemSupport to increase the SUs awareness and encourage self reporting. Use easy read/videos, pictoral charts etc.Knowledge of risk factors/history of individualEffective monitoring allows us to take appropriate action

13. Effective monitoring

14. Effective monitoringAppropriate physical examination/investigation by relevant medical professionalObservation for changes in presentationPain when going to the toilet?Soiled underwear? – could be overflow? – caution when considering stopping laxatives!!!Diet charts – having enough fibre?Fluid charts – drinking enough fluid?Stool charts – no bowel movement in 3 days?Bowel management protocols – a plan of what to do - Be aware of normal bowel habits and to recognise when there is a problem for the individual Review bowel management/care plans regularlyReview advice/bowel medication with the GPAssessment of toileting equipment/correct positioning

15. Effective positioning

16. Case StudiesLaura – Autism and challenging behaviour. Lives at home with parents. Persevered with monitoring. Identified constipation as a trigger to escalation in behavioural incidents. Reviewed with GP. Bowel care plan put into place.Christopher – Mild LD and Autism. Involved increasing awareness, self reporting. Used Youtube videos to explain constipation and how you can help avoid this. Used a bowel chart with pictures to tick each day. Currently bowels are well managed. Alfie – change in diet and toileting times. Profound physical disabilites, severe LD. Diet improvements through increase in fibre and fluid intake. Identified opening bowels regularly after eating, then provided time on toilet at effective time. Introduced to passive bowel exercises by physiotherapist. New toileting equipment provided by OT. At discharge bowels were well managed.(names changed for confidentiality).

17. Increasing individual’s awarenessVideosEasy read resourcesJourney of the cheeseburgerPictures Social storiesMake self reporting easier – use photos, pictures, tick charts etc.

18. To recapIncreased risk for our service usersCauses Constipation can become a serious health issue if left untreatedThe carer has a key role in providing awareness and promoting effective monitoring

19. NHS England leaflets on constipation

20. References and ResourcesReferences ‘Making reasonable adjustments for people with learning disabilities in the management of constipation’ (DoH 2016).‘Faecal Incontinence in adults:Management’ (2007) available at nice.org.uk‘Constipation’ (2019) NHS UK available at nhs.uk/conditions/constipationERIC, The children’s bowel and bladder charity.Links to NHS England constipation informationhttps://www.england.nhs.uk/wp-content/uploads/2019/05/constipation-resources-easy-read.pdfhttps://www.england.nhs.uk/wp-content/uploads/2019/05/constipation-resources-hcp-31-print-ready.pdf https://www.england.nhs.uk/wp-content/uploads/2019/05/constipation-resources-families-carers-stage-31-print-ready.pdf