The prevalence of constipation in institutionalized people with intellectual disability.
Constipation is rampant in adults with ID, drives behavior, and BCBAs are often the first to notice.
01Research in Context
What this study did
Doctors visited every large state facility in Israel. They checked the bowel records of the adults with intellectual disability.
Staff noted who had fewer than three stools a week, hard stools, or needed laxatives. The team also recorded IQ, mobility, medicines, and diet.
What they found
Seven out of ten residents were constipated. Non-walkers, people with cerebral palsy, and those on antipsychotics or seizure drugs were hit hardest.
Lower IQ and food refusal also raised risk. Constipation was so common it looked normal to staff.
How this fits with other research
Shepherd et al. (2021) extends these numbers to autistic older adults on Medicare. Their claims show the same heavy GI burden, proving the problem lasts across settings and ages.
Lomas Mevers et al. (2020) offers hope. Their small RCT gave autistic kids with encopresis a medical-plus-behavioral plan. Sixty percent reached continence, showing bowel issues can be treated once spotted.
Kozak et al. (2013) reminds us staff burnout is high in these same facilities. Overlooked constipation may add to daily care stress, feeding the burnout loop.
Why it matters
You can spot constipation before it turns into aggression or self-injury. Add a quick bowel question to your intake. Track stool patterns on the same sheet you use for behavior data. If a client starts new meds, loses mobility, or refuses food, flag for GI review and hand the data to the nurse. Early medical care can cut pain, reduce problem behavior, and make your behavior plan work faster.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add one bowel-movement box to your daily behavior sheet and share weekly totals with the medical team.
02At a glance
03Original abstract
Constipation is a common problem in people with intellectual disability (ID). Laxatives are frequently prescribed with disappointing results. The prevalence of constipation was investigated in a random population of 215 people with ID (IQ < 50) and constipation was correlated with clinical symptoms. All subjects were scored for bowel habits. Constipation was defined as having a bowel movement less than three times a week or the necessity of using laxatives more than three times a week. Further possible accompanying factors were evaluated. The control subjects were defined as individuals who did not use laxatives. Subjects with constipation were defined as patients and were compared to subjects without constipation (controls). One hundred and forty-nine out of 215 cases (69.3%) showed constipation. Constipation was significantly correlated with non-ambulancy, cerebral palsy, the use of anticonvulsive medication or benzodiazepines, H2-receptor antagonists or proton pump inhibitors, food refusal, and an IQ < 35. Fifty-eight per cent of the patients used bisacodyl or magnesium oxide, 39% lactulose, 13% sodiumlaurylsulphoacetate/sodium citrate/sorbitol and only 10% were given sodium phosphate enemas. Faecal soiling was found in 15% of subjects, while manual evacuation of faeces was performed in nearly 7% of cases. Constipation was randomly demonstrated in almost 70% of the population with ID. Subjects with the above-mentioned accompanying factors are especially at risk for constipation. Contrary to the general population, constipation in people with ID is associated with little use of phosphate enemas, microlax, a low incidence of faecal soiling and manual evacuation of faeces, suggesting an aetiology without distal faecal impaction. The regimen and effect of therapy has to be studied to define adequate treatment schedules.
Journal of intellectual disability research : JIDR, 2001 · doi:10.1046/j.1365-2788.2001.00300.x