Managing constipation in adult social care settings

Page last updated: 3 June 2025

Constipation means either going to the toilet less often than usual to empty the bowels or passing hard or painful stools (faeces). It is a common condition, and it affects people of all ages.

Constipation can lead to faecal impaction. This is when constipation is so severe the person cannot clear it out, and faeces block the bowels.

When someone is severely impacted, uncontrolled watery or loose stools sometimes bypass the blockage, giving the false impression that the constipation has cleared. This risks a serious, and potentially fatal, condition going unrecognised.

Causes of constipation

Constipation in adults has many possible causes, but sometimes the cause is not clear.

The most common causes include:

  • not eating enough fibre, for example in fruits, vegetables and cereals
  • not drinking enough fluids
  • being less active, not exercising and spending long periods sitting or lying down
  • often ignoring the urge to go to the toilet
  • a change to diet or daily routine
  • a side effect of medicine
  • stress, anxiety or depression
  • an underlying medical condition.

Identifying people at risk of constipation

Providers must have a system to identify people who may be at risk of constipation.

Healthcare professionals can help you to do this as certain medical conditions and medicines can increase the risk. 

Your systems should identify red flag signs or symptoms that may suggest a serious underlying cause, such as colorectal cancer.

Consider the risk of constipation in people who:

  • are over 65 (as they have slower metabolism and less muscle strength in their digestive tract)
  • are less able to communicate. For example, people living with dementia, people with a learning disability and autistic people
  • are taking medicines known to cause constipation as a side effect. For example:
    • iron supplements
    • anti-psychotics
    • antiepileptics
    • some painkillers
    • some blood pressure medicines
    • some anti-depressants
    • some antacids.

Check patient information leaflets to see if they list constipation as a side effect.

  • are not mobile or who do not get enough physical activity
  • do not drink enough fluids, have a low fibre diet or low-calorie intake.
  • have difficulty accessing the toilet or a lack of privacy.

Managing constipation

Laxatives are a group of medicines that can treat constipation. These are offered if advice on lifestyle measures, such as increasing dietary fibre, and ensuring adequate fluid intake and activity levels has had no effect.

If using laxatives, NICE guidance about constipation advises gradually titrating the laxative dose(s) up or down aiming to produce soft, formed stools without straining at least 3 times a week.

Monitoring constipation

A range of tools can be helpful in monitoring constipation.

From NHS England:

The Bristol stool chart is a visual aid that can help stimulate conversations about healthy poo and enable someone to identify if they are experiencing constipation.

The chart can be printed and made available to people using the service and their carers.

Care planning

You should have a person-centred care plan for people at risk of constipation. This should be reviewed regularly and whenever people’s needs change.

This should include:

  • What is normal for them. Look out for any behaviour changes, as it might mean someone is in pain or discomfort.
  • An assessment of the support they may need with their diet to encourage fluid and fibre intake and to ensure adequate mobility/exercise.
  • Clear information on the person/people responsible for monitoring bowel habits, conscious of people’s capacity.
  • Details of who to escalate any concerns to.
  • Information on the use of any ‘when required’ (PRN) medicines for managing constipation, especially when more than one medicine is prescribed to relieve constipation or when a choice of dose is given.
  • What to do if someone has not opened their bowels for a specific period (as defined by their person-centred care plan).
  • When to seek support from the GP, community nurses, or emergency services.
  • Any person-centred dietary requirements.
  • Any person-centred cultural requirements.

Managing constipation in people who have a learning disability

People with a learning disability are at a higher risk of constipation. It has been suggested that between a third to half of people with a learning disability suffer from chronic constipation.

Constipation in people with a learning disability can be life-threatening. People have died as a result of faecal impaction. Constipation can also lead to other complications, for example a heart attack.

People may also be less likely to recognise the symptoms of constipation and be able to communicate their symptoms effectively. This can increase the risk of serious consequences.

Many people with a learning disability require support with toileting and maintaining a good toilet routine. However, carers can sometimes be so cautious about respecting privacy that they inadvertently neglect people’s support needs around bowel management and monitoring. This is why robust care planning and monitoring can make a real difference to people’s outcomes, preventing hospitalisation and avoidable deaths.

Many medications prescribed may cause constipation as a side effect. For example, medicines for epilepsy and antipsychotics are far more commonly used than in the general population. Both types of medicines can cause constipation as a side effect.

NHS England has published helpful resources to raise awareness of managing constipation in people with a learning disability:

People with more severe physical disability may also have a greater risk of constipation. This can be due to many factors such as lifestyle factors, higher levels of obesity and lower levels of exercise than the rest of the population. The risk of constipation is even higher in people with Down’s syndrome.

Managing constipation in people taking clozapine

When taking clozapine, constipation can be fatal.

See Managing constipation in people taking clozapine.

Further information