Let's Talk Poop--Bowel Movements and End of Life Care

Let’s talk about a topic that is often overlooked in our medical end of life care: bowel movements. Why bring up a subject that is difficult to discuss? Because there are major misconceptions about bowel movements in people who can’t be fixed and people who are taking medicines for pain, narcotics and/or non-narcotics. Everybody has bowel movements, everyone needs to have them, yet in our prudishness we tend to not talk about them. I think we are embarrassed to bring up the subject but we need to. So, here I go.

We often think that when a person is not eating very much they will then not have much to eliminate. Wrong. Whether we eat or not our body still produces waste and we will still need to eliminate that waste.

Being active helps us poop therefore the less active we are, and people approaching the end of their life through disease or old age gradually have less and less energy hence do less and sleep more, the more prone to constipation we will be. Constipation becomes a problem as activity decreases. Laxatives become necessary.

Narcotic and non-narcotic pain medicines slow bodily functions and constipation becomes a big issue. Anyone taking medication for pain needs to be taking a laxative. Pain medicine and laxatives go together, always. Don’t wait until the person is impacted with three or four days of backed up stool and in great discomfort before considering a laxative.

So, most people with a life threatening illness need to be assessed for a laxative regime. Of course there are exceptions, the particular disease and the person’s bowel history can affect and determine bowel activity, but everyone needs to be assessed. Ninety nine percent of people on pain medicine will need to also be on a laxative.

What kind of laxative? Ask the doctor who prescribed the pain medicine what is recommended. Generally, the stronger the pain medicine the stronger the laxative.

Something More... about Let's Talk Poop...

Caring for someone at end of life is challenging and when pain is part of the dying process, the challenge intensifies. That's why I wrote Pain At End of Life: What You Need To Know About End of Life Comfort and Pain Management. It addresses, in fifth grade, non-medical terminology:

  • pain as it relates to the dying process
  • fear of overdosing and addiction
  • standardized dosages
  • around the clock administration
  • laxatives
  • uses of morphine
  • sedation as it relates to dying
  • supplemental therapies

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53 comments

barbara

Hi Joanne, it does sound like your mum has entered the dying process (weeks to days) The fact that she asked about her bowels tells me she is not as close as I originally thought reading your comments. Do you have a mild laxative you can give her? Is she complaining of discomfort, pressure in the area of her rectum? That could suggest stool is just sitting inside the opening. Do you have hospice services or nurses coming to your home? If so ask them to check her for an impaction and what laxative to give her. Sounds like you are not in the US so it is challenging to get my booklets to you but you can get Gone From My Sight and The Eleventh Hour in Ebook form, both would be helpful for you now. Email me at Barbara@bkbooks.com if I can be of further help. Blessings to you and your mum during this time. Barbara

joanne

my mum is 91 weighs under 4 stone and is near end of life , were just keeping her comfortable at home. last few days shes slept nearly all day. today shes a little brighter. shes ate 8 teaspoonful of puree pear over 3 days im lucky to get half a cup of drink in her. and urine now very low. today shes asked why shes not had bowels open for days. is it because of the stage shes at in life ?. please email me your reply if you have one thank you

barbara

Hi Tamela,
I am disappointed your mother’s doctor didn’t offer you more help. Not controlling your bowels is not necessarily a part of aging, although having 9 children could mean that the muscles in that area are not as strong as they once were. You might ask her doctor if anti-diarrhea medication would help as I’m thinking the increase in fiber did not help. I’m sorry to say that adult diapers might be in your future. My blessings to you and your mom. Barbara

Tamela

My mom is 88, and other than arthritis, and Afib, she is relatively healthy. However, the past few months she has started getting diarrhea, and many times she doesn’t make it to the bathroom in time. Is this just part of aging? Her doctor doesn’t seem too concerned about it, and has told her to up her fiber. She is depressed and keeps talking about wanting to die. Side note: Not sure if this is important, but she has given birth to 9 kids.

barbara

Hi Kim, I do not have enough medical history or information on your mom to say why she is not aware of pooping. Is dementia involved? If the stool is very loose then maybe too much fiber and poop inducing foods but most likely it is just her mental state declining. If she hasn’t had a doctors appointment in a while it might be time for a physical or just call her doctor and ask what could be happening. It might just be time to get the adult diapers out. What about urine. Does she know when she is peeing? If she knows when she has to pee then not knowing when she poops is something for the doctor to know about. Also any medication changes that could be affecting this? So many questions, so few answers. . Blessings! Barbara

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