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In February this year, an inquest into the premature death of a 33-year-old man concluded that gross failures in care had led to his death. Mr Richard Hanley had learning disabilities, some mental health problems and had lifelong constipation. This was managed effectively when he lived in residential care; however, when he moved to supported living he became constipated. His family reported that his abdomen resembled that of a woman about to give birth. Mr Handley was admitted to hospital and 10kg of faeces was surgically removed from his body two days before his death. The coroner determined that the causes of death were inhalation of gastric contents, large bowel obstruction and faecal impaction ( BBC News, 2018 ; Hill, 2018 ; Inquest, 2018 ). Constipation is often considered a minor problem; however, it can have serious and even life-threatening consequences. Each year, 66 287 people are admitted to hospital because of constipation ( Department of Health (DH), 2015 ). The NHS spends around £250 million pounds annually treating constipation. Hospital admissions cost £145 million and primary care spends around £92 million in laxative prescriptions ( DH, 2015 ; Shafe et al, 2011 : NHS Information Centre, 2016 ). This article aims to enable readers to be aware of how normal bowel function varies in individuals, how ageing, frailty, long-term conditions and medication affect bowel function, how to promote normal bowel function and to manage constipation.

Constipation refers to difficulty in passing stool, accompanied by excessive straining, or complaint of infrequent bowel movements. Caring for patients who experience constipation is a common aspect of working as a healthcare assistant (HCA) or an assistant practitioner (AP). For some patients, the treatment of constipation is essential to their medical management. It is important for HCAs to know that constipation is often caused by underlying anatomical or functional problems.

Caring for patients who experience constipation is a common feature of clinical nursing practice, for some patients’ this is essential to their medical management. Constipation is a symptom and not a disease which is often a result of an underlying anatomical or functional problem. The term constipation can mean different things to different people. It can be a feeling of difficulty of passing stool, accompanied by excessive straining; or a complaint of infrequent bowel movements. Frequency of bowel movement varies widely in the population, and it is considered normal to pass stools between three times a day and three times a week.

Healthcare assistants may well assist other healthcare professionals to provide bowel care for patients who have had a spinal injury. This care, often complex in nature, needs to be holistically planned for each patient, which avoids crisis management in this very bothersome problem. Autonomic Dysreflexia is classified as an acute medical emergency, whereby removal of the offending stimulus, as described by Cardozo (1997) usually offers a complete cure.