Constipation

Constipation is the most common gastrointestinal complaint in autistic people as well as in the general population. For many people, constipation is a chronic health problem that can develop and persist at any point in the lifespan.

Signs of constipation include:

• three or fewer bowel movements a week

• lumpy or hard stools

• pain during bowel movements

• difficulty completely emptying the bowel.

Symptoms of constipation can present differently in autistic people, especially those with more severe language and cognitive impairments. For example, contorting the body in unusual ways can indicate abdominal pain. Dr. Tim Buie, a pediatric gastroenterologist at Boston Children’s Hospital, notes that his autistic patients sometime exhibit “behaviors such as pressing their bellies onto a chair, leaning onto furniture, or lying flat on their bellies to kind of seek pressure on their bellies. That's a common thing that people have associated with constipation.” These behaviors may indicate the need to consult a gastroenterologist. In this video, Dr. Buie explains some of the behaviors that may indicate digestive upset:

Functional fecal retention (FFR)

Functional fecal retention (FFR) is a gastrological condition that appears frequently in autistic people. It is characterized by more regularly occurring stools but with less complete evacuation. Because the bowel is never completely empty, even with regular toileting occurrences, symptoms such as abdominal pain, bloating, or toileting accidents caused by a loss of control of the pelvic floor muscles can develop. Anxiety, sensory, or attention issues can contribute to the development of FFR. Note that anxiety might not initially be directly related to toileting issues, but if constipation persists it can itself become a source of anxiety and lead to FFR.

Tracking toileting patterns

In addition to caregivers, personal care attendants and group home staff can provide feedback on any patterns such as constipation, FFR, soiling, withholding, or not using the toilet often enough. Tracking toileting behaviors and characteristics of bowel movement can help provide much needed detail for the PCP or gastroenterologist. The Bristol Stool Chart is a useful tool specifically for tracking bowel movements. Caregivers and autistic patients can record data and look for patterns that, in consultation with a PCP or gastroenterologist, can identify and address sources of constipation.

Lifestyle changes to help ease constipation

Diet and certain medications can contribute to chronic constipation. Autistic adults will want to have regular conversations with a gastroenterologist (and possibly a nutritionist) to determine the underlying causes and best approaches for managing it. Caregivers are advised to take cues from the autistic adult’s clinician and avoid making diet, food, or exercise into battleground issues, as stress and anxiety can lead to or exacerbate bowel issues.

Lifestyle changes that may be helpful for constipation include staying hydrated by drinking plenty of water and eating foods that are rich in water and/or fiber. Keep in mind that adjustments in diet should be approached slowly; adding or eliminating one kind of food at a time will make it easier to measure the impact of the change. A nutritionist can provide more tailored recommendations for autistic adults; however, some general examples of foods to help alleviate constipation include:

• whole-grain breads

• oatmeal

• beans and chickpeas

• veggies: carrots, broccoli, peas, and collard greens

• nuts: peanuts, almonds, and pecans

• fruit: berries, apples, and pears

High-fat foods tend to be low in fiber and can slow down digestion. Foods that are high in processed sugar, salt, and/or fat content, and low in water, can contribute to chronic constipation. Limit or avoid foods such as:

• fast food, such as french fries and chicken nuggets

• processed meats with nitrates like hot dogs and sausages

• salty snack foods

Regular exercise helps stimulate bowel movement, so daily movement such as walking or swimming can help with chronic constipation. Frequent use of over-the-counter laxatives should be avoided.

For those in day programs or who live in residential placements, communication about dietary health can assist in managing conditions like constipation. Our Dietary Plan Tool is one way of helping caregivers and staff understand and maintain good health in autistic adults.