IS14 November 2017 Information Sheet

Constipation and faecal impaction

Normal bowel function varies from • problems with catheter drainage person to person. For some people, • overflow diarrhoea having three bowel movements a day would be considered normal; for Infrequent episodes of constipation are others, a bowel movement every two usually nothing to worry about. However, to three days is normal. We tend not to constipation can be a symptom of several be comfortable discussing our bowel different conditions, so it is important to habits publicly, but most of us will seek advice from your doctor if you start experience constipation at some point. to get constipated regularly, or if other symptoms develop like unexplained weight loss or blood in any stools you pass. What is constipation? Left untreated, constipation can lead to Constipation is a change in a person’s more serious and painful conditions such as bowel pattern or function. Someone can be haemorrhoids, fissures and faecal impaction. said to be constipated if they are passing hard stools infrequently and with difficulty. Causes of constipation Symptoms of constipation include: The most common causes • stools (faeces) become hard and of constipation are: difficult or painful to pass • Lack of fluids – fluids help to • bloating in the abdomen soften the stools and make them • feelings of nausea easier to pass. Dry, hard stools • sometimes pain low down are more difficult to pass. in the abdomen • Lack of fibre in the diet – dietary fibre • bad breath gives bulk to help speed the passage • bad taste in the mouth of waste products through the bowel. • reduced appetite • Lack of exercise or reduced mobility • lethargy – activity helps stimulate the muscle • restlessness contractions needed to keep the • confusion waste moving through your system. • general inability to function normally • Side effect of medication – constipation is a common side effect • faecal incontinence of many medicines or combinations of • retention of urine medicines. Pain killers are particularly • incontinence of urine prone to cause constipation.

Page 1 Constipation and faecal impaction

As people get older they may start to damage to the brain, so the person may develop problems with their bowels as be less aware of the sensation of stool the relevant muscles age and deteriorate. in the rectum, leading to constipation. They may also be less active, reduce their People with severe cognitive problems may fluid intake, have a reduced appetite or become less aware of their bowel habits difficulty eating sufficient dietary fibre. and depend on other people for their care People with neurological conditions such or if they cannot easily find or access the as Multiple Sclerosis, Parkinson’s toilet, this can also affect their bowel habits. disease and strokes are also more Constipation in people with dementia can prone to constipation. This may be the lead to a worsening of their confusion, as effect these conditions have on the well as causing irritability. This is thought relevant muscles and nerves as well to be due to the pain and discomfort of as the reduction in physical activity, the constipation; but if constipation is not swallowing problems, medication and diagnosed it may be assumed that these possible psychological impact. symptoms are just part of the person’s dementia. This can lead to the person not Functional constipation or receiving treatment for constipation. primary constipation Preventing constipation Some people may have underactive bowels, which can lead to them experiencing There are various things we can do ‘functional’ or ‘primary’ constipation. Despite to help keep our bowels healthy: having a good diet, drinking a lot of fluid • Drink adequate amounts of fluids to and being active, without any disease or keep the stools soft - at least 6-8 taking any medication, some people still water based drinks a day (approx 1.5 become constipated. Most cases occur in to 2 litres). Introducing soft jellies, women and the condition tends to start ice cream and soups may help. at an early age and persist into later life. • Eat more high-fibre foods such as wholegrain bread, wholegrain breakfast Constipation and dementia cereals, fruit and vegetables. However, be aware that you must also increase your The ageing process, lifestyle and treatment fluid intake in line with your fibre intake. for other medical conditions may pre- • Increase your physical activity as this dispose some people with dementia to helps to increase bowel activity. For frail develop constipation. Dementia itself may elderly and immobile people, seated also lead a person to become constipated. exercises, walking short distances, or standing up from a chair may help. To control our bowel, we must be aware • Pay attention to bowel signals, and of the need to empty our bowel. This awareness happens when the faeces don’t ignore them - if you feel the move into the rectum, causing it to urge, go as soon as possible. expand and send messages to the brain • Know your own bowel habits – each that the bowel needs to be emptied. of us will have times when our bowels are at their most active, particularly a In the early and mid stages of dementia, certain time after meals. When we eat this may not be a problem. However, as we stimulate activity throughout our the illness progresses, there is increased digestive system, helping to move stool

Page 2 Constipation and faecal impaction

through the gut ready to be pushed out. A change of diet and routine, combined This is especially so after breakfast. By with inactivity and the possible impact attempting to open your bowels after of treatment, leads to many people a meal the gastrocolic reflex can help experiencing constipation while in hospital you to empty your bowel more easily. or on return from hospital. This is even Timing your bowel care or toileting after worse for people with dementia who may a meal may make it more effective. need encouragement to eat and drink, and • Sit on the toilet properly. Sitting support at the right time to go to the toilet. up straight makes it easier to push If a person with dementia is being stools out without straining. You admitted to hospital, ensure they take a may need to use a footstool in front ‘Getting to know me’ form with them to of the toilet to help with this. help doctors and nurses make their stay People with dementia are likely to more comfortable. Call the Dementia need support to keep up a healthy Helpline (details at the end of this bowel regime as their condition information sheet) for more information. progresses. Establishing a regular toilet routine may be needed if the person is Faecal impaction ignoring the urge to go to the toilet. Faecal impaction is less well recognised What if you suspect than constipation. In this condition, dried hard stools collect in the rectum, someone is constipated? obstructing it and preventing the person from passing the stools naturally. As At home the mass of stools becomes bigger and Partners and family members should be more impacted, the rectum is stretched alert for any changes which could signal and enlarged, so the muscles within it that the person is constipated so it can be don’t work so well to push stools out. treated as early as possible. Knowing the Faecal impaction can also cause faecal person’s habits and routine can help greatly. incontinence. This happens when It may be useful to keep a diary loose stools from above is squeezed of the person’s bowel movements around the blockage and the person diet and fluid intake as well as any having no control over their bowels. changes you observe as this could People with dementia, particularly in the help the doctor make a diagnosis. later stages of the illness, may be unable Simple measures like increasing to describe the pain they are experiencing the person’s fluids and dietary fibre due to the mass of impacted stools might help to begin with, but if that developing in their bowel, which can does not work, speak to the person’s lead to them being wrongly diagnosed. GP and ask for a review of any Faecal impaction is also linked to acute medications and possible treatment. states of confusion and delirium in the elderly hospital population; if someone In hospital has dementia, faecal impaction is likely to If the person with dementia is in hospital make their dementia symptoms worse. or has just returned home from a spell in hospital, you should be particularly alert to the possibility of constipation.

Page 3 Constipation and faecal impaction

Treatment for constipation often needed for a while, to prevent the problem recurring. If faecal impaction is Laxatives – macrogol (polyethlene glycol not treated this can lead to serious bowel ‘3350’) is a type of medicine known as an problems e.g. a bowel obstruction. osmotic laxative. It passes through the gut without being absorbed into the body. It Preventing constipation relieves constipation because it causes the water it is mixed with to be retained in the future in the bowel instead of being absorbed into the body. This increases the water Your GP and pharmacist can discuss content and volume of the stools in the suitable treatments and ways of bowel, making them softer and easier to preventing the problem happening again. pass. Brand names for this kind of laxative If medication is causing constipation, include Movicol, and Laxido Orange. there may be another brand or form of drug which will not have this side effect. Treatment for faecal impaction Your GP can refer you to the community nurses or bladder and bowel nursing Suppositories - this type of medicine is service who can help with assessing, inserted via your anus. The suppository treating or managing your constipation gradually dissolves at body temperature or faecal impaction and help with and irritates the lining of the rectum, any bowel incontinence problems. promoting a bowel movement. Micro-enema - this is when a medicine in Further information fluid form is inserted via your anus and into your rectum promoting a bowel movement. The Bladder and Bowel Foundation is a charity which provides help, information and Removal of faeces – if the rectum is very support for all types of bladder and bowel full, the faeces may need to be removed related problems. They provide confidential by a nurse inserting a finger into the anus. advice and support from their helpline on Temporarily, symptoms of diarrhoea 0845 345 0165. For specific information and incontinence may worsen, but it is on constipation, visit their website at: important to keep up with treatment, www.bladderandbowelfoundation.org/ to clear the blockage. After the large bowel/bowel-problems/constipation amount of stool is cleared, laxatives are

Alzheimer Scotland 160 Dundee Street Edinburgh EH11 1DQ Email: [email protected] Tel: 0131 243 1453 www.alzscot.org

Alzheimer Scotland – Action on Dementia is a company limited by guarantee, registered in Scotland 149069. Registered office: 160 Dundee Street, Edinburgh EH11 1DQ. It is recognised as a charity by the Office of the Scottish Charity Regulator, no, SC022315

Page 4