One-third to half of people with intellectual disabilities suffer from chronic constipation (defined as two or fewer bowel movements weekly or taking regular laxatives three or more times weekly), a cause of significant morbidity and premature mortality. Research on risk factors associated with constipation is limited.

To enumerate risk factors associated with constipation in this population.

A questionnaire was developed on possible risk factors for constipation. The questionnaire was sent to carers of people with intellectual disabilities on the case-loads of four specialist intellectual disability services in England. Data analysis focused on descriptively summarising responses and comparing those reported with and without constipation.

Of the 181 people with intellectual disabilities whose carers returned the questionnaire, 42% reported chronic constipation. Constipation was significantly associated with more severe intellectual disability, dysphagia, cerebral palsy, poor mobility, polypharmacy including antipsychotics and antiseizure medication, and the need for greater toileting support. There were no associations with age or gender.

People with intellectual disabilities may be more vulnerable to chronic constipation if they are more severely intellectually disabled. The associations of constipation with dysphagia, cerebral palsy, poor mobility and the need for greater toileting support suggests people with intellectual disabilities with significant physical disabilities are more at risk. People with the above disabilities need closer monitoring of their bowel health. Reducing medication to the minimum necessary may reduce the risk of constipation and is a modifiable risk factor that it is important to monitor. By screening patients using the constipation questionnaire, individualised bowel care plans could be implemented.

Purple urine bag syndrome (PUBS) is a condition that causes an intense purple discoloration of the urine, predominately in frail, dependent, and bedridden persons who are chronically catheterized and have urinary tract infections. Despite being considered a benign syndrome, PUBS can cause great anxiety, fear, and distress in health professionals, chronically ill persons, and caregivers or family members who provide care.

We report the case of a 98-year-old institutionalized woman with Alzheimer’s dementia with a long-term urinary catheter who developed PUBS.

Although alarming and distressing for the resident and the health-care team, PUBS was resolved by treating the underlying urinary tract infection and applying good genital hygiene and catheter replacement.

Identifying PUBS and its clinical features and management proved to be significantly helpful in ameliorating the anxiety, fear, and distress around the phenomenon.

Successful stabilization of patients with mental disorders requires most of the times the use of more than one antipsychotic medications with increase prevalence of clozapine in refractory cases. Constipation consists one of the most debilitating side effect of the therapy, which gradually progresses to a chronic state of bowel movement dysfunction, with recurrent episode of paralytic ileus of various severity.

We describe the case of a middle age male treated with clozapine for refractory mental disorder, who developed ileus and subsequent bowel dysfunction not amenable to laxatives.

The acute episode have been treated conservatively with nasogastric decompression, intravenous replacement of fluids and electrolytes, antibiotics chemoprophylaxis and low molecular weight heparin. His overall physical status was unremarkable for obesity, diabetes, hypertension, allergies, previous operations and a former endoscopic evaluation conducted in the recent past, which had ruled out malignant neoplastic disease.

A course of per os prucalopride have been instituted, which showed preliminary promising results in restoring proper bowel movements, without any serious side effect and without the need to discontinue his course with antipsychotics. Prucalopride is a 5 HT4 agonist which selectively binds to the receptors of the intestine, resulting in muscular contractions as well as clorium secretion from the mucosa promoting an osmotic defecation.The substance has been extensively use in the treatment of irritable bowel disease of the chronic constipation type.

We suggest the more systematic use of this agent in this group of patients after proper endoscopic evaluation and restoration of all secondary causes of constipation.

No significant relationships.

To characterize 1) the relationship between laxative use and objective sleep metrics, and 2) the relationship between laxative use and self-reported insomnia symptoms in a convenience sample of middle-aged/elderly patients who completed in-laboratory polysomnography.

We cross-sectionally analyzed first-night diagnostic in-laboratory polysomnography data for 2946 patients over the age of 40 (mean age 60.5 years; 48.3% male). Laxative use and medical comorbidities were obtained through self-reported questionnaires. Patient insomnia symptoms were based on self-report. Associations between laxative use and objective sleep continuity were analyzed using multivariable linear regression models. Associations between laxative use and insomnia were assessed using multivariable logistic regression models.

After adjusting for age, sex, body mass index, total recording time, and relevant comorbidities, laxative users had a 7.1% lower sleep efficiency (p < 0.001), 25.5-minute higher wake after sleep onset (p < 0.001), and a 29.4-minute lower total sleep time (p < 0.001) than patients not using laxatives. Laxative users were found to be at greater odds of reporting insomnia symptoms (OR = 1.7, p = 0.024) than patients not using laxatives.

Laxative use is associated with impairments in objective sleep continuity. Patients using laxatives were also at greater odds of reporting insomnia symptoms.